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General NPI Number Information
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NPI Number | 1538579453
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Entity Type | Organization
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Legal Business Name | WILSON CHIROPRACTIC & WELLNESS LLC
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 700 HIGHLAND AVE
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City | FORT ATKINSON
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State | WI
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Zip | 53538-2749
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Country | US
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Telephone | 920-542-1028
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Fax | 920-542-1027
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Provider Business Mailing Address
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Address Line | 700 HIGHLAND AVE
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City | FORT ATKINSON
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State | WI
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Zip | 53538-2749
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Country | US
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Telephone | 920-542-1028
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Fax | 920-542-1027
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Authorized Official
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Title or Position | CO-OWNER
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Name | STEPHANIE TRONNES WILSON
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Credential | D.C.
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Telephone | 920-542-1028
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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 | 4867-12
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4978-12
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License Number State | WI
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