Organization
INTERGRATED PAIN AND SPINE CARE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY KIRK (CREDENTIALING SPECIALIST)
(414) 967-9000
Entity
Organization
Contact information
Practice address
5261 N PORT WASHINGTON RD STE 100, MILWAUKEE, WI 53217-4903
(414) 967-9000
(414) 332-3712
Mailing address
PO BOX 170181, GLENDALE, WI 53217-8016
(414) 967-9000
(414) 332-3712
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
3812-012
WI
Other
Enumeration date
10/10/2017
Last updated
06/20/2018
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