# IMAGINE CHIROPRACTIC AND WELLNESS CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306102066
- **Authorized official:** DR. ANGELA RENEE THIELE D.C. (OWNER/CHIROPRACTOR)
- **Authorized official phone:** (920) 327-3752

## Contact information

- **Practice address:** 445 CARDINAL LN STE 110, GREEN BAY, WI 54313-9577
- **Practice address phone:** (920) 327-3752
- **Mailing address:** 445 CARDINAL LN STE 110, GREEN BAY, WI 54313-9577
- **Mailing address phone:** (920) 327-3752

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 4371-012 | WI | Yes |
| 111NS0005X | Sports Physician Chiropractor | 5028 | WI | — |

## Other

- **Enumeration date:** 04/06/2012
- **Last updated:** 04/06/2012