Provider Demographics
NPI:1538579453
Name:WILSON CHIROPRACTIC & WELLNESS LLC
Entity type:Organization
Organization Name:WILSON CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:TRONNES
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-542-1028
Mailing Address - Street 1:700 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2749
Mailing Address - Country:US
Mailing Address - Phone:920-542-1028
Mailing Address - Fax:920-542-1027
Practice Address - Street 1:700 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-2749
Practice Address - Country:US
Practice Address - Phone:920-542-1028
Practice Address - Fax:920-542-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4867-12111N00000X
WI4978-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty