MEDICARE: CHIROPLUS COMPLIMENTARY HEALTH CARE CENTER 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	3020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144385873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPLUS COMPLIMENTARY HEALTH CARE CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 458
Second Line	:
City	:	GREEN LAKE
State	:	WI
Zip	:	54941-0458
Country	:	US
Telephone Number	:	920-294-3130
Fax Number	:	920-294-3238

Provider Business Practice Location Address
First Line	:	505 LAKE STREET
Second Line	:
City	:	GREEN LAKE
State	:	WI
Zip	:	54941
Country	:	US
Telephone Number	:	920-294-3130
Fax Number	:	920-294-3238

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. COLLEEN POMPLUN
Credential	:	DC
Telephone Number	:	920-294-3130

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	05/24/2011

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