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General NPI Number Information
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NPI Number | 1184158974
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Entity Type | Organization
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Legal Business Name | INFINITE ATHLETE CHIROPRACTIC & REHAB LLC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 5964 EXECUTIVE DR
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City | FITCHBURG
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State | WI
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Zip | 53719-5311
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Country | US
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Telephone | 608-720-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 5964 EXECUTIVE DR
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City | FITCHBURG
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State | WI
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Zip | 53719-5311
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Country | US
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Telephone | 608-720-1144
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Fax |
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Authorized Official
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Title or Position | CO-OWNER, CHIROPRACTOR
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Name | DR. ELIZABETH PASKEY
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Credential | D.C.
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Telephone | 608-720-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 5222-12
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License Number State | WI
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