=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295040343
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZUMSTEIN CHIROPRACTIC CLINIC, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2010
-----------------------------------------------------
Last Update Date | 08/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8233 S. 27TH ST.
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-761-3330
-----------------------------------------------------
Fax | 414-761-3363
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8233 S 27TH ST
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53132-9310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-761-3330
-----------------------------------------------------
Fax | 414-761-3363
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. DAVID P. ZUMSTEIN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 414-761-3330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3436-012
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------