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General NPI Number Information
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NPI Number | 1578783379
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Entity Type | Organization
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Legal Business Name | JAMES M. POWELL DC,SC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1185 CORPORATE CENTER DR
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4845
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Country | US
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Telephone | 262-928-8411
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Fax |
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Provider Business Mailing Address
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Address Line | 1185 CORPORATE CENTER DR
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4845
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES POWELL
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Credential | DC
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Telephone | 262-928-8411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2172
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License Number State | WI
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