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General NPI Number Information
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NPI Number | 1144598814
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Entity Type | Organization
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Legal Business Name | ROSENDALE CHIROPRACTIC OFFICE, LLC
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 100 LAFAYETTE ST
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City | ROSENDALE
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State | WI
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Zip | 54974-9661
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Country | US
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Telephone | 920-872-2969
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Fax |
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Provider Business Mailing Address
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Address Line | 100 LAFAYETTE ST PO BOX 51
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City | ROSENDALE
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State | WI
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Zip | 54974-9661
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Country | US
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Telephone | 920-872-2969
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA ELLEN ROTH SHARP
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Credential | DC
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Telephone | 920-872-2969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2604-12
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License Number State | WI
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