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Organization
SIMPLY CHIROPRACTIC, LLC
Active
Organization
SIMPLY CHIROPRACTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE C PETERSON D.C. (MEMBER/OWNER)
(715) 233-1867
Entity
Organization
Contact information
Practice address
2303 SCHNEIDER AVE SE, SUITE 150, MENOMONIE, WI 54751-7005
(715) 233-1867
Mailing address
2303 SCHNEIDER AVE SE, SUITE 150, MENOMONIE, WI 54751-7005
(715) 233-1867
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3763
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3763
SATE LICENSE
WI
Enumeration date
07/13/2006
Last updated
08/22/2020
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