MEDICARE: INTEGRATED HEALTH SERVICES OF DOOR COUNTY INC.

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	111NS0005X	Sports Physician Chiropractor	4387012	WI

General Provider Information

NPI Number	:	1073915500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED HEALTH SERVICES OF DOOR COUNTY INC.

Provider Business Mailing Address
First Line	:	6214 STATE HIGHWAY 42
Second Line	:
City	:	EGG HARBOR
State	:	WI
Zip	:	54209-9135
Country	:	US
Telephone Number	:	920-256-2865
Fax Number	:

Provider Business Practice Location Address
First Line	:	6214 STATE HIGHWAY 42
Second Line	:
City	:	EGG HARBOR
State	:	WI
Zip	:	54209-9135
Country	:	US
Telephone Number	:	920-256-2865
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ZACHARY JOHN PAUL
Credential	:	D.C.
Telephone Number	:	920-366-9455

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	02/05/2015

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