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620 Warren St # 1, Redgranite, WI 54970-9391 | |
(920) 566-0767 | |
(920) 566-0768 |
Full Name | |
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Type | Facility |
Speciality | Chiropractor |
Location | 620 Warren St # 1, Redgranite, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1245337559 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | 4106 (Wisconsin) | Primary |
Provider Name | Eric S Boettcher |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1750306957 PECOS PAC ID: 2668428558 Enrollment ID: I20050323001214 |
Mailing Address | Practice Location Address |
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Po Box 447, Redgranite, WI 54970-0447 Ph: (920) 566-0767 | 620 Warren St # 1, Redgranite, WI 54970-9391 Ph: (920) 566-0767 |
Dr. Eric Steven Boettcher, D.C. Chiropractor Medicare: Accepting Medicare Assignments Practice Location: 620 Warren St # 1, Redgranite, WI 54970 Phone: 920-566-0767 Fax: 920-566-0768 |