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General NPI Number Information
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NPI Number | 1932411873
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Entity Type | Organization
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Legal Business Name | INSPIRING VITALITY WELLNESS INSTITUTE LLC
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 2920 ENLOE ST SUITE 105
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City | HUDSON
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State | WI
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Zip | 54016-8190
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Country | US
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Telephone | 715-808-0716
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Fax | 715-808-0807
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Provider Business Mailing Address
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Address Line | 2920 ENLOE ST SUITE 105
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City | HUDSON
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State | WI
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Zip | 54016-8190
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Country | US
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Telephone | 715-808-0716
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Fax | 715-808-0807
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Authorized Official
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Title or Position | OWNER
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Name | DARYL LEE COOPER
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Credential | DC
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Telephone | 715-808-0716
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1664-012
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License Number State | WI
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