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General NPI Number Information
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NPI Number | 1558659946
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Entity Type | Organization
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Legal Business Name | BRIDGE STREET CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 502 N BRIDGE ST
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-2421
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Country | US
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Telephone | 715-861-5255
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Fax | 715-861-5275
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Provider Business Mailing Address
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Address Line | 502 N BRIDGE ST
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-2421
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Country | US
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Telephone | 715-861-5255
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Fax | 715-861-5275
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JAMES KOLMER
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Credential | D.C.
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Telephone | 715-861-5255
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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 | 1499-12
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License Number State | WI
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