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General NPI Number Information
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NPI Number | 1689681280
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Entity Type | Organization
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Legal Business Name | HARTLAND CHIROPRACTIC HEALTH CARE
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | N50W34768 WISCONSIN AVE
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City | NASHTOAH
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State | WI
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Zip | 53069-9750
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Country | US
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Telephone | 262-367-0606
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Fax | 262-367-0609
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Provider Business Mailing Address
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Address Line | N50W34768 WISCONSIN AVE
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City | OKAUCHEE
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State | WI
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Zip | 53069-9750
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Country | US
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Telephone | 262-367-0606
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Fax | 262-367-0609
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE CHARLES SHAWHAN
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Credential | D.C.
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Telephone | 262-367-0606
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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 | 3204
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License Number State | WI
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