Healthcare Provider Details

I. General information

NPI: 1538228374
Provider Name (Legal Business Name): NIEDERMANN CHIROPRACTIC S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W WISCONSIN AVE SUITE B
APPLETON WI
54911-4327
US

IV. Provider business mailing address

324 W WISCONSIN AVE SUITE B
APPLETON WI
54911-4327
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-2434
  • Fax: 920-731-8007
Mailing address:
  • Phone: 920-731-2434
  • Fax: 920-731-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1803
License Number StateWI

VIII. Authorized Official

Name: DR. KARL ANTHONY NIEDERMANN
Title or Position: CEO
Credential: D.C.
Phone: 920-731-2434