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General NPI Number Information
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NPI Number | 1750441630
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Entity Type | Organization
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Legal Business Name | BACK & NECK WELLNESS CENTER INC.
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 12/21/2022
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Provider Practice Location Address
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Address Line | 4222 MILWAUKEE ST 83
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City | MADISON
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State | WI
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Zip | 53714-3508
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Country | US
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Telephone | 608-222-4244
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Fax | 608-222-9341
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Provider Business Mailing Address
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Address Line | 4222 MILWAUKEE ST 83
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City | MADISON
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State | WI
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Zip | 53714-3508
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Country | US
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Telephone | 608-222-4244
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Fax | 608-222-9341
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS BONNIE JEAN LANGREHR
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Credential | D.C.
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Telephone | 608-222-4244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2250-012
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License Number State | WI
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