Healthcare Provider Details

I. General information

NPI: 1235285099
Provider Name (Legal Business Name): ANTHONY J BAWEK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S DETTLOFF DR
ARCADIA WI
54612-1702
US

IV. Provider business mailing address

305 S DETTLOFF DRIVE
ARCADIA WI
54612-1702
US

V. Phone/Fax

Practice location:
  • Phone: 608-323-7651
  • Fax: 608-323-7651
Mailing address:
  • Phone: 608-323-7651
  • Fax: 608-323-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4282-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: