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General NPI Number Information
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NPI Number | 1508073800
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CENTER OF MONROE, S.C.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 765 10TH AVENUE CT.
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City | MONROE
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State | WI
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Zip | 53566-1427
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Country | US
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Telephone | 608-328-2225
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Fax | 608-328-2436
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Provider Business Mailing Address
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Address Line | 765 10TH AVENUE CT.
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City | MONROE
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State | WI
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Zip | 53566-1427
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Country | US
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Telephone | 608-328-2225
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Fax | 608-328-2436
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM DAVID SPONTAK
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Credential | D. C.
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Telephone | 608-328-2225
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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 | 2609
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License Number State | WI
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