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General NPI Number Information
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NPI Number | 1972797876
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Entity Type | Organization
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Legal Business Name | OCONNOR CHIROPRACTIC OFFICE, S.C.
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 4777 8TH ST S SUITE A
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-7858
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Country | US
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Telephone | 715-424-1880
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Fax | 715-424-2528
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Provider Business Mailing Address
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Address Line | 4777 8TH ST S SUITE A
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-7858
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Country | US
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Telephone | 715-424-1880
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Fax | 715-424-2528
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATTI JO O'CONNOR
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Credential |
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Telephone | 715-424-1880
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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 | 1403-012
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License Number State | WI
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