MEDICARE: ON-SITE CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1043865603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON-SITE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2029 COUNTY HIGHWAY I STE 5
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-4420
Country	:	US
Telephone Number	:	715-720-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2029 COUNTY HIGHWAY I STE 5
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-4420
Country	:	US
Telephone Number	:	715-720-8500
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	AMANDA DANIELLE HAINES
Credential	:	DC
Telephone Number	:	330-933-8235

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	08/09/2019

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Directions to “ON-SITE CHIROPRACTIC LLC ” Practice Location

Language	Start Address	Practice Location

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