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General NPI Number Information
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NPI Number | 1609400704
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Entity Type | Individual
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Provider Name | JOSEPH CORNEJO L.AC.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 527 W WATER ST
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City | PRINCETON
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State | WI
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Zip | 54968-9142
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Country | US
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Telephone | 920-755-0527
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Fax |
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Provider Business Mailing Address
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Address Line | 4957 S MEADOW PARK LN APT 204
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City | GREENFIELD
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State | WI
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Zip | 53220-5332
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Country | US
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Telephone | 414-640-2585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 580-55
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License Number State | WI
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