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General NPI Number Information
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NPI Number | 1275788895
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Entity Type | Organization
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Legal Business Name | DELTA LLC
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 344 E WASHINGTON ST
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City | SLINGER
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State | WI
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Zip | 53086-9587
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Country | US
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Telephone | 262-623-7373
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Fax |
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Provider Business Mailing Address
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Address Line | W344 HIGHWAY DW
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City | THERESA
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State | WI
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Zip | 53091
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Country | US
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Telephone | 262-623-7373
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JAMES PETERS
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Credential | D.C.
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Telephone | 262-623-7373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4445-012
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License Number State | WI
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