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General NPI Number Information
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NPI Number | 1376045534
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Entity Type | Organization
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Legal Business Name | MILWAUKEE CHIROPRACTIC AND REHAB, LLC
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 03/05/2018
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Provider Practice Location Address
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Address Line | 4111 N PORT WASHINGTON RD
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City | MILWAUKEE
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State | WI
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Zip | 53212-1029
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Country | US
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Telephone | 414-395-1279
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Fax |
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Provider Business Mailing Address
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Address Line | 4111 N PORT WASHINGTON RD
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City | MILWAUKEE
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State | WI
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Zip | 53212-1029
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Country | US
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Telephone | 414-395-1279
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAD SLODEN
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Credential | DC
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Telephone | 414-395-1279
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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 | 4600-012
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License Number State | WI
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