MEDICARE: WISCONSIN CHIROPRACTIC & WELLNESS 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	3534-12	WI

General Provider Information

NPI Number	:	1821417882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISCONSIN CHIROPRACTIC & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	163 E NORTH WATER ST
Second Line	:
City	:	NEENAH
State	:	WI
Zip	:	54956-2708
Country	:	US
Telephone Number	:	920-486-4031
Fax Number	:	920-725-2909

Provider Business Practice Location Address
First Line	:	163 E NORTH WATER ST
Second Line	:
City	:	NEENAH
State	:	WI
Zip	:	54956-2708
Country	:	US
Telephone Number	:	920-486-4031
Fax Number	:	920-725-2909

Authorized Official
Title or Position	:	OWNER
Name	:	HOANVU QUANG NGUYEN
Credential	:	D.C.
Telephone Number	:	920-486-4031

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	04/07/2014

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