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General NPI Number Information
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NPI Number | 1881141737
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Entity Type | Organization
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Legal Business Name | IMPERIUM CHIROPRACTIC
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 3301 GOLF RD SUITE 102
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4682
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Country | US
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Telephone | 715-514-4302
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Fax |
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Provider Business Mailing Address
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Address Line | W8646 US HIGHWAY 8
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City | LADYSMITH
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State | WI
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Zip | 54848-9501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | ROBYN TOZER
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Credential |
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Telephone | 715-532-6394
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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 | 3324-12
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License Number State | WI
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