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General NPI Number Information
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NPI Number | 1710308564
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Entity Type | Organization
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Legal Business Name | VANNATTA CHIROPRACTIC
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Dates
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Enumeration Date | 12/20/2013
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 1250 E. BUSINESS HIGHWAY 151 SUITE H.
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City | PLATTEVILLE
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State | WI
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Zip | 53818
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Country | US
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Telephone | 608-732-5545
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Fax |
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Provider Business Mailing Address
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Address Line | 430 E MAIN ST.
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City | PLATTEVILLE
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State | WI
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Zip | 53818
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Country | US
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Telephone | 608-732-5545
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR/AUTHORIZED OFFIC
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Name | DR. MANDY VANNATTA
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Credential | DC
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Telephone | 608-732-5545
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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 | 4756-12
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License Number State | WI
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