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General NPI Number Information
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NPI Number | 1164831673
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC ASSOCIATES OF KENOSHA, S.C.
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 3120 80TH ST
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City | KENOSHA
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State | WI
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Zip | 53142-4946
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Country | US
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Telephone | 262-942-9955
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Fax | 262-942-9958
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Provider Business Mailing Address
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Address Line | 3120 80TH ST
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City | KENOSHA
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State | WI
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Zip | 53142-4946
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Country | US
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Telephone | 262-942-9955
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Fax | 262-942-9958
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MICHAEL A TRABBOLD
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Credential | DC
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Telephone | 262-942-9955
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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 | 3665
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License Number State | WI
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