=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356099170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ETERNAL HOPE CHIROPRACTIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2022
-----------------------------------------------------
Last Update Date | 03/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2211 PARMENTER ST STE 1
-----------------------------------------------------
City | MIDDLETON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53562-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-999-5077
-----------------------------------------------------
Fax | 608-999-5076
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2211 PARMENTER ST STE 1
-----------------------------------------------------
City | MIDDLETON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53562-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-999-5077
-----------------------------------------------------
Fax | 608-999-5076
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. KAYLA MARIE FRANZLUEBBERS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 608-999-5077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------