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General NPI Number Information
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NPI Number | 1407919525
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Entity Type | Organization
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Legal Business Name | CLOVER CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 1576 LYON DR
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City | NEENAH
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State | WI
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Zip | 54956-5069
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Country | US
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Telephone | 920-722-7947
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Fax | 920-722-7949
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Provider Business Mailing Address
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Address Line | PO BOX 246
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City | NEENAH
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State | WI
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Zip | 54957-0246
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Country | US
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Telephone | 920-722-7947
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Fax | 920-722-7949
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW CLOVER
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Credential | D.C.
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Telephone | 920-722-7947
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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 | 4089-012
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License Number State | WI
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