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General NPI Number Information
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NPI Number | 1699064022
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Entity Type | Organization
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Legal Business Name | PROHEALTH CHIROPRACTIC CENTER S.C.
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 321 CARROLL ST
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City | RANDOM LAKE
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State | WI
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Zip | 53075-1813
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Country | US
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Telephone | 920-994-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 321 CARROLL ST
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City | RANDOM LAKE
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State | WI
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Zip | 53075-1813
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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 | OWNER
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Name | DR. ERIC STANENAS
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Credential | D.C.
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Telephone | 414-617-9470
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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 |
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License Number State |
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