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General NPI Number Information
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NPI Number | 1477724276
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Entity Type | Organization
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Legal Business Name | WASHA CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 1415 STATE ROAD 16
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City | LA CROSSE
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State | WI
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Zip | 54601-2980
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Country | US
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Telephone | 608-785-7746
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Fax | 608-782-2938
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Provider Business Mailing Address
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Address Line | 1415 HWY 16
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City | LA CROSSE
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State | WI
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Zip | 54601
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Country | US
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Telephone | 608-785-7746
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Fax | 608-782-2938
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID M WASHA
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Credential | DC
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Telephone | 608-785-7746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2535
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License Number State | WI
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