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Organization

SPRING INTO LIFE CHIROPRACTIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TRAVIS DIEDERICH D.C. (OWNER)
(715) 845-6800
Entity
Organization

Contact information

Practice address
903 S 17TH AVE, SUITE D, WAUSAU, WI 54401-5700
(715) 845-6800
Mailing address
903 S 17TH AVE, SUITE D, WAUSAU, WI 54401-5700

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4097
WI

Other

Enumeration date
04/23/2010
Last updated
04/23/2010
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