=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881868768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICK M MURPHY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2008
-----------------------------------------------------
Last Update Date | 06/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 875 N ORANGE ST
-----------------------------------------------------
City | RICHLAND CENTER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-647-6211
-----------------------------------------------------
Fax | 608-647-4422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 611 875 N ORANGE ST
-----------------------------------------------------
City | RICHLAND CENTER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-647-6211
-----------------------------------------------------
Fax | 608-647-4422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER OPERATOR
-----------------------------------------------------
Name | DR. PATRICK M MURPHY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 608-647-6211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1967
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------