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NPI Code Detail

MEDICARE: LAKE WISSOTA FAMILY CHIROPRACTIC

MEDICARE: LAKE WISSOTA FAMILY CHIROPRACTIC
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
1111N00000XChiropractor4436-012WI

General Provider Information

NPI Number : 1407007420
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE WISSOTA FAMILY CHIROPRACTIC
Provider Business Mailing Address
First Line : 107 N BRIDGE ST
Second Line :
City : CHIPPEWA FALLS
State : WI
Zip : 54729-2404
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 107 N BRIDGE ST
Second Line :
City : CHIPPEWA FALLS
State : WI
Zip : 54729-2404
Country : US
Telephone Number : 715-720-2887
Fax Number :
Authorized Official
Title or Position : DOCTOR OF CHIROPRACTIC
Name : DR. AMY GAMERDINGER JEFFERS
Credential : D.C.
Telephone Number : 715-720-2887
Provider Enumeration Date : 10/08/2008
Last Update Date : 01/14/2019

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Directions to “LAKE WISSOTA FAMILY CHIROPRACTIC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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