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General NPI Number Information
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NPI Number | 1295975654
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Entity Type | Organization
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Legal Business Name | BODY & SPINE CHIROPRACTIC WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 6200 NESBITT RD
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City | FITCHBURG
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State | WI
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Zip | 53719-1819
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Country | US
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Telephone | 608-558-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 3902 MAPLE GROVE DR APT 9
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City | MADISON
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State | WI
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Zip | 53719-1768
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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 | DOCTOR OF CHIROPRACTIC
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Name | DR. CHARITY JOY ROOD
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Credential | D.C.
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Telephone | 608-558-1711
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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 | 4369-012
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License Number State | WI
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