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General NPI Number Information
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NPI Number | 1629063458
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Entity Type | Organization
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Legal Business Name | DR THOMAS J SOLECKI JR SC
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 6123 GREEN BAY RD SUITE 140
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City | KENOSHA
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State | WI
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Zip | 53142-2927
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Country | US
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Telephone | 262-653-9208
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Fax | 262-653-9264
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Provider Business Mailing Address
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Address Line | PO BOX 158
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City | KENOSHA
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State | WI
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Zip | 53141-0158
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Country | US
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Telephone | 262-925-9000
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Fax | 262-925-8997
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MICHELLE ELIZABETH COUNTERMAN
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Credential |
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Telephone | 262-925-9000
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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 | 038009230
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3590
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License Number State | WI
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