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General NPI Number Information
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NPI Number | 1487834156
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Entity Type | Organization
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Legal Business Name | TOUCHBACK CHIROPRACTIC AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 445 CARDINAL LN SUITE 106
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City | GREEN BAY
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State | WI
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Zip | 54313-9577
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Country | US
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Telephone | 920-246-8470
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Fax |
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Provider Business Mailing Address
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Address Line | 2443 MOCKINGBIRD LN
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City | GREEN BAY
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State | WI
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Zip | 54303-6275
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Country | US
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Telephone | 920-246-8470
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. TUCKER ANTHONY EMERSON
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Credential | D.C.
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Telephone | 920-246-8470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4342-012
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License Number State | WI
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