MEDICARE: ROBERT GLENN CASTEEL D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3599-012	WI

General Provider Information

NPI Number	:	1588684559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT GLENN CASTEEL D.C.

Provider Business Mailing Address
First Line	:	2311 UNIVERSITY AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-4501
Country	:	US
Telephone Number	:	920-406-3981
Fax Number	:	920-465-1072

Provider Business Practice Location Address
First Line	:	2311 UNIVERSITY AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-4501
Country	:	US
Telephone Number	:	920-406-3981
Fax Number	:	920-465-1072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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