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General NPI Number Information
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NPI Number | 1154030674
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Entity Type | Organization
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Legal Business Name | 360 CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 10834 W DENIS AVE
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City | HALES CORNERS
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State | WI
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Zip | 53130-1920
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Country | US
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Telephone | 608-921-6653
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Fax |
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Provider Business Mailing Address
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Address Line | 10834 W DENIS AVE
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City | HALES CORNERS
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State | WI
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Zip | 53130-1920
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Country | US
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Telephone | 608-921-6653
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAIGE OLSON
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Credential | DC
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Telephone | 608-921-6653
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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 |
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License Number State |
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