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General NPI Number Information
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NPI Number | 1538043344
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Entity Type | Organization
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Legal Business Name | HERITAGE HEALTH
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 416 W MAIN ST
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City | CAMBRIDGE
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State | WI
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Zip | 53523-9144
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Country | US
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Telephone | 608-423-4666
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 117
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City | SULLIVAN
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State | WI
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Zip | 53178-0117
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Country | US
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Telephone | 319-321-2494
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY WILBANKS
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Credential | DC
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Telephone | 319-321-2494
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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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