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General NPI Number Information
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NPI Number | 1700554714
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Entity Type | Organization
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Legal Business Name | RESTORE FAMILY CHIROPRACTIC, INC
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 331 E PRAIRIE VIEW RD
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3463
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Country | US
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Telephone | 715-861-3174
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Fax | 715-861-5000
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Provider Business Mailing Address
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Address Line | 331 E PRAIRIE VIEW RD
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3463
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Country | US
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Telephone | 715-861-3174
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Fax | 715-861-5000
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | KRISTIN MARIE WAHL
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Credential | DC
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Telephone | 715-861-3174
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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 |
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License Number State |
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