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General NPI Number Information
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NPI Number | 1568173326
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Entity Type | Organization
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Legal Business Name | WINNEBAGO WELLNESS LLC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 102 N 13TH AVE
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City | WINNECONNE
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State | WI
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Zip | 54986
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Country | US
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Telephone | 920-385-9499
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Fax |
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Provider Business Mailing Address
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Address Line | 9517 LAURA LN
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City | WINNECONNE
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State | WI
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Zip | 54986-9627
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Country | US
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Telephone | 608-547-1379
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. ADAM FRANCIS MOOTZ
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Credential | DC
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Telephone | 920-385-9499
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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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