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General NPI Number Information
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NPI Number | 1861218067
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Entity Type | Organization
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Legal Business Name | SYMMETRY SPINE CARE LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 1201 OAK ST STE O
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City | WEST BEND
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State | WI
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Zip | 53095-3800
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Country | US
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Telephone | 262-346-1936
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 OAK ST STE O
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City | WEST BEND
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State | WI
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Zip | 53095-3800
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Country | US
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Telephone | 262-346-1936
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA GURROLA
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Credential | DC
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Telephone | 262-346-1936
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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 |
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License Number State |
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