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General NPI Number Information
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NPI Number | 1760725329
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Entity Type | Organization
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Legal Business Name | BODY WAVE CORPORATION
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Dates
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Enumeration Date | 04/02/2013
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 2984 TRIVERTON PIKE DR STE. 102
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City | FITCHBURG
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State | WI
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Zip | 53711-5841
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Country | US
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Telephone | 608-556-1705
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Fax |
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Provider Business Mailing Address
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Address Line | 2984 TRIVERTON PIKE DR STE. 102
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City | FITCHBURG
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State | WI
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Zip | 53711-5841
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Country | US
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Telephone | 608-556-1705
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA ANN KONOPACKI
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Credential | D.C.
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Telephone | 608-556-1705
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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 | 391512
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License Number State | WI
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