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General NPI Number Information
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NPI Number | 1205265022
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Entity Type | Organization
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Legal Business Name | CHIRO LIFE CLINIC LLC
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 12/24/2013
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Provider Practice Location Address
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Address Line | 1052 WITZEL AVE
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City | OSHKOSH
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State | WI
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Zip | 54902-5720
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Country | US
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Telephone | 920-203-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 860 FARMINGTON AVE
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City | OSHKOSH
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State | WI
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Zip | 54901-1172
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KHAM SING XIONG
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Credential | D.C.
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Telephone | 920-203-0477
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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 | 4928-12
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License Number State | WI
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