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General NPI Number Information
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NPI Number | 1821333550
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Entity Type | Organization
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Legal Business Name | MILWAUKEE SPINE AND JOINT CENTER
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 1631 W LINCOLN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-2637
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Country | US
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Telephone | 414-643-9000
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Fax | 414-643-9004
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Provider Business Mailing Address
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Address Line | 1631 W LINCOLN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-2637
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Country | US
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Telephone | 414-643-9000
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Fax | 414-643-9004
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Authorized Official
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Title or Position | CHIROPRACTOR-CLINIC DIRECTOR
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Name | DR. KELLY WORTH
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Credential | D.C.
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Telephone | 414-643-9000
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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 | 4264-012
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License Number State | WI
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