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General NPI Number Information
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NPI Number | 1316095185
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Entity Type | Organization
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Legal Business Name | COUNTRYVIEW CHIROPRACTIC CLINIC, S.C.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | W5675 CTY HWY B
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City | SHAWANO
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State | WI
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Zip | 54166-0060
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Country | US
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Telephone | 715-526-6158
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Fax | 715-526-6178
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Provider Business Mailing Address
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Address Line | PO BOX 60
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City | SHAWANO
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State | WI
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Zip | 54166-0060
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Country | US
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Telephone | 715-526-6158
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Fax | 715-526-6178
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD WARREN PENSIS
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Credential | D.C.
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Telephone | 715-526-6158
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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 |
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License Number State |
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