Organization
IMAGINE CHIROPRACTIC AND WELLNESS CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA RENEE THIELE D.C. (OWNER/CHIROPRACTOR)
(920) 327-3752
Entity
Organization
Contact information
Practice address
445 CARDINAL LN STE 110, GREEN BAY, WI 54313-9577
(920) 327-3752
Mailing address
445 CARDINAL LN STE 110, GREEN BAY, WI 54313-9577
(920) 327-3752
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4371-012
WI
111NS0005X
Sports Physician Chiropractor
5028
WI
Other
Enumeration date
04/06/2012
Last updated
04/06/2012
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