MEDICARE: ALLIANCE 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1942499330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	156 S CENTRAL AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-2833
Country	:	US
Telephone Number	:	715-384-9064
Fax Number	:	715-387-6954

Provider Business Practice Location Address
First Line	:	156 S CENTRAL AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-2833
Country	:	US
Telephone Number	:	715-384-9064
Fax Number	:	715-387-6954

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARGARET MERTENS
Credential	:	D.C.
Telephone Number	:	715-384-9064

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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