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General NPI Number Information
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NPI Number | 1326262916
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Entity Type | Organization
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Legal Business Name | RACINE CHIROPRACTIC LTD
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3845 DOUGLAS AVE
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City | RACINE
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State | WI
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Zip | 53402-3228
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Country | US
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Telephone | 262-639-9514
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Fax | 262-639-9529
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Provider Business Mailing Address
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Address Line | 3845 DOUGLAS AVE
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City | RACINE
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State | WI
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Zip | 53402-3228
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Country | US
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Telephone | 262-639-9514
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Fax | 262-639-9529
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Authorized Official
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Title or Position | DIRECTOR
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Name | WILSON MBURU
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Credential |
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Telephone | 262-639-9514
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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 | 2314-012
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License Number State | WI
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