52D2073179 CLIA NUMBER - EARLY CLINIC OF CHIROPRACTIC LLC

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Laboratory Demographics

CLIA Number: 52D2073179

Facility Name: EARLY CLINIC OF CHIROPRACTIC LLC

Facility Address:
1211 RICKMEYER DR, SUITE F
FOND DU LAC, WI
ZIP 54937
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Facility Phone Number: 920 322-9594

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1922207612

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	52D2073179
LAB Type	Physician Office
Facility Name	EARLY CLINIC OF CHIROPRACTIC LLC
Street	1211 RICKMEYER DR, SUITE F
City	FOND DU LAC
State	WI
ZIP	54937
Phone	920 322-9594
CertificateType	4
CertificateEffectiveDate	2/12/2024
CertificateExpirationDate	2/11/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024