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General NPI Number Information
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NPI Number | 1467832899
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Entity Type | Organization
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Legal Business Name | KLUEWER CHIROPRACTIC, INC
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 1229 N CENTER ST
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City | BEAVER DAM
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State | WI
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Zip | 53916-1147
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Country | US
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Telephone | 920-219-9322
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Fax | 920-219-9323
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Provider Business Mailing Address
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Address Line | 1229 N CENTER ST
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City | BEAVER DAM
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State | WI
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Zip | 53916-1147
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Country | US
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Telephone | 920-219-9322
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Fax | 920-219-9323
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JORDAN MARK KLUEWER
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Credential | D.C.
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Telephone | 920-253-7374
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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 | 4936-12
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License Number State | WI
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