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General NPI Number Information
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NPI Number | 1700470044
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Entity Type | Organization
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Legal Business Name | OMRO CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 02/26/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 215 JACKSON AVE
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City | OMRO
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State | WI
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Zip | 54963-1429
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Country | US
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Telephone | 920-685-6788
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Fax |
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Provider Business Mailing Address
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Address Line | 215 JACKSON AVE
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City | OMRO
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State | WI
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Zip | 54963-1429
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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/CHIROPRACTOR
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Name | MICHAEL STERTZ
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Credential | DC
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Telephone | 920-685-6788
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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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