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General NPI Number Information
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NPI Number | 1255701496
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC HEALTH SERVICE SC
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 500 BIRCH ST
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City | PARK FALLS
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State | WI
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Zip | 54552-1415
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Country | US
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Telephone | 715-762-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 500 BIRCH ST PO BOX 189
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City | PARK FALLS
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State | WI
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Zip | 54552-1415
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Country | US
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Telephone | 715-762-2950
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY S WAKEFIELD
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Credential | DC
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Telephone | 715-762-2950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3939-24
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2521-012
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License Number State | WI
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