52D2195186 CLIA NUMBER - COMMUNITY CARE CLINIC/ AKA BRONSTON CHIRO CLINIC/ CHIROMED LLC

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Laboratory Demographics

CLIA Number: 52D2195186

Facility Name: COMMUNITY CARE CLINIC/ AKA BRONSTON CHIRO CLINIC/ CHIROMED LLC

Facility Address:
1202 COUNTY ROAD PH SUITE 100
ONALASKA, WI
ZIP 54650
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Facility Phone Number: 608 781-2225

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1225573785

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D2195186
LAB Type	Community Clinic
Facility Name	COMMUNITY CARE CLINIC/ AKA BRONSTON CHIRO CLINIC/ CHIROMED LLC
Street	1202 COUNTY ROAD PH SUITE 100
City	ONALASKA
State	WI
ZIP	54650
Phone	608 781-2225
CertificateType	4
CertificateEffectiveDate	10/7/2022
CertificateExpirationDate	10/6/2024
FacilityType	Waiver

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