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NPI Code Detail

MEDICARE: BACK & NECK WELLNESS CENTER INC.

MEDICARE: BACK & NECK WELLNESS CENTER 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
1111NS0005XSports Physician Chiropractor2250-012WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11699741801OTHERWINPI NUMBER

General Provider Information

NPI Number : 1750441630
Entity Type Code : Organization
Provider Name (Legal Business Name) : BACK & NECK WELLNESS CENTER INC.
Provider Business Mailing Address
First Line : 4222 MILWAUKEE ST
Second Line : 83
City : MADISON
State : WI
Zip : 53714-3508
Country : US
Telephone Number : 608-222-4244
Fax Number : 608-222-9341
Provider Business Practice Location Address
First Line : 4222 MILWAUKEE ST
Second Line : 83
City : MADISON
State : WI
Zip : 53714-3508
Country : US
Telephone Number : 608-222-4244
Fax Number : 608-222-9341
Authorized Official
Title or Position : PRESIDENT
Name : MISS BONNIE JEAN LANGREHR
Credential : D.C.
Telephone Number : 608-222-4244
Provider Enumeration Date : 12/11/2006
Last Update Date : 12/21/2022

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