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General NPI Number Information
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NPI Number | 1710221908
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Entity Type | Organization
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Legal Business Name | CENTER OF CHIROPRACTIC NEUROLOGY INC
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Dates
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Enumeration Date | 11/12/2012
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 620 JACKSON ST
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City | SAUK CITY
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State | WI
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Zip | 53583-1463
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Country | US
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Telephone | 608-370-7328
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Fax | 608-237-3119
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Provider Business Mailing Address
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Address Line | 620 JACKSON ST
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City | SAUK CITY
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State | WI
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Zip | 53583-1463
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Country | US
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Telephone | 608-370-7328
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Fax | 608-237-3119
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. DONALD JOSEPH PFAU
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Credential | DC
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Telephone | 608-370-7328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | 4222-012
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License Number State | WI
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