Organization
ROSENDALE CHIROPRACTIC OFFICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA ELLEN ROTH SHARP DC (OWNER)
(920) 872-2969
Entity
Organization
Contact information
Practice address
100 LAFAYETTE ST, ROSENDALE, WI 54974-9661
(920) 872-2969
Mailing address
100 LAFAYETTE ST, PO BOX 51, ROSENDALE, WI 54974-9661
(920) 872-2969
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2604-12
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000070216
MEDICARE PTAN
WI
Enumeration date
12/08/2011
Last updated
05/11/2012
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