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General NPI Number Information
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NPI Number | 1750576542
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Entity Type | Organization
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Legal Business Name | DORN CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 888 THACKERAY TRL SUITE 210
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4342
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Country | US
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Telephone | 262-560-9600
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Fax | 262-560-9599
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Provider Business Mailing Address
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Address Line | 888 THACKERAY TRL SUITE 210
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4342
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Country | US
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Telephone | 262-560-9600
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Fax | 262-560-9599
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Authorized Official
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Title or Position | OWNER OF DORN CHIROPRACTIC, LLC.
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Name | DR. BRADY DORN
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Credential | DC
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Telephone | 262-560-9600
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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 | 3622-012
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License Number State | WI
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