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General NPI Number Information
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NPI Number | 1447758354
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Entity Type | Organization
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Legal Business Name | OSHKOSH SPINE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 1210 S KOELLER ST
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City | OSHKOSH
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State | WI
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Zip | 54902-6170
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Country | US
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Telephone | 920-235-0000
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Fax | 920-235-3522
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Provider Business Mailing Address
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Address Line | PO BOX 62
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City | MANAWA
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State | WI
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Zip | 54949-0062
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Country | US
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Telephone | 920-277-8940
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. DAVID DONALD JOSEPH AUGUSTINE
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Credential | DC
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Telephone | 920-277-8940
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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 | 5293-12
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License Number State | WI
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