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General NPI Number Information
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NPI Number | 1306987771
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Entity Type | Organization
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Legal Business Name | CHIPPEWA VALLEY NEUROSCIENCES LLC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 950 W CLAIREMONT AVE SUITE B
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6176
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Country | US
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Telephone | 715-831-0811
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Fax | 715-831-0802
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Provider Business Mailing Address
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Address Line | 3506 OAKWOOD MALL DR STE A
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City | EAU CLAIRE
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State | WI
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Zip | 54701-2639
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Country | US
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Telephone | 715-831-0811
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Fax | 715-831-0802
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Authorized Official
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Title or Position | OWNER
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Name | DR. JON P KONZEN
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Credential | DO
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Telephone | 715-831-0811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 37138021
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License Number State | WI
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