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General NPI Number Information
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NPI Number | 1326345166
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Entity Type | Organization
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Legal Business Name | CROSSROADS CHIROPRACTIC JOHNSON CREEK LLC
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 545 VILLAGE WALK LN SUITE C
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City | JOHNSON CREEK
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State | WI
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Zip | 53038
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Country | US
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Telephone | 920-728-4070
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 117
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City | JOHNSON CREEK
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State | WI
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Zip | 53038-0117
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Country | US
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Telephone | 920-728-4070
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KIMBERLY D TURNER
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Credential | DC
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Telephone | 920-728-4070
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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 | 4573-012
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License Number State | WI
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