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General NPI Number Information
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NPI Number | 1487028205
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Entity Type | Organization
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Legal Business Name | WOLF RIVER CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | N5644 STATE HIGHWAY 76
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City | SHIOCTON
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State | WI
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Zip | 54170-8612
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Country | US
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Telephone | 920-240-4441
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Fax | 920-240-4442
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Provider Business Mailing Address
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Address Line | N5644 STATE HIGHWAY 76
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City | SHIOCTON
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State | WI
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Zip | 54170-8612
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Country | US
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Telephone | 920-240-4441
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Fax | 920-240-4442
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOLENE MARIE GARVEY PINTAR
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Credential | DC
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Telephone | 920-240-4441
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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 | 4305-012
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License Number State | WI
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