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General NPI Number Information
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NPI Number | 1407053911
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Entity Type | Organization
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Legal Business Name | MAYVILLE CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 1 S MAIN ST
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City | MAYVILLE
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State | WI
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Zip | 53050-1641
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Country | US
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Telephone | 920-387-5995
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Fax | 920-387-5887
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Provider Business Mailing Address
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Address Line | 1 S MAIN ST
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City | MAYVILLE
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State | WI
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Zip | 53050-1641
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Country | US
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Telephone | 920-387-5995
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Fax | 920-387-5887
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JOHN T RIEGLEMAN
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Credential | D.C.
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Telephone | 920-387-5995
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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 | 2075-012
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License Number State | WI
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