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General NPI Number Information
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NPI Number | 1477587681
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Entity Type | Organization
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Legal Business Name | NORTHEAST WISCONSIN SPINE CENTERS
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1720 N 8TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-2773
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Country | US
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Telephone | 920-803-2225
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Fax | 920-803-3001
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Provider Business Mailing Address
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Address Line | 1720 N 8TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-2773
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Country | US
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Telephone | 920-803-2225
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Fax | 920-803-3001
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA JAMES HEIMERL
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Credential | D.C.
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Telephone | 920-803-2225
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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 |
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License Number State |
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