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General NPI Number Information
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NPI Number | 1154712552
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Entity Type | Organization
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Legal Business Name | DRIFTLESS CHIROPRACTIC AND SPINAL REHAB LLC
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Dates
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Enumeration Date | 02/07/2015
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 1022 19TH ST S
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City | LA CROSSE
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State | WI
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Zip | 54601-5811
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Country | US
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Telephone | 608-519-5690
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 19TH ST S
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City | LA CROSSE
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State | WI
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Zip | 54601-5811
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Country | US
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Telephone | 858-997-9320
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER/PRESIDENT
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Name | MRS. SHAUNA RAE MUNDINGER
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Credential | D.C.
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Telephone | 858-997-9320
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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 | 5028-12
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License Number State | WI
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