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General NPI Number Information
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NPI Number | 1770894164
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Entity Type | Organization
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Legal Business Name | ODONNELLS FRAME BODY CHIROPRACTIC
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 507 WEBSTER AVE
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City | SAUK CITY
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State | WI
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Zip | 53583-1144
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Country | US
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Telephone | 608-370-3807
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Fax |
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Provider Business Mailing Address
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Address Line | 507 WEBSTER AVE
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City | SAUK CITY
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State | WI
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Zip | 53583-1144
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Country | US
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Telephone | 608-370-3807
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | DR. DENNIS MICHAEL O'DONNELL
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Credential | DC
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Telephone | 608-370-3807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3669-012
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License Number State | WI
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