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General NPI Number Information
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NPI Number | 1558080028
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Entity Type | Organization
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Legal Business Name | WISDOM CHIROPRACTIC INCORPORATED
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 155 ELM ST STE 2
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City | MONTPELIER
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State | VT
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Zip | 05602-4467
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Country | US
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Telephone | 802-229-4922
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Fax |
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Provider Business Mailing Address
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Address Line | 155 ELM ST STE 2
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City | MONTPELIER
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State | VT
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Zip | 05602-4467
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Country | US
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Telephone | 802-229-4922
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONALD K WISDOM
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Credential | DC
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Telephone | 802-229-4922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number |
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License Number State |
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