Healthcare Provider Details

I. General information

NPI: 1376636878
Provider Name (Legal Business Name): DENNIS EUGENE SEVERSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 W LINCOLN ST SUITE 2
AUGUSTA WI
54722-9152
US

IV. Provider business mailing address

154 W LINCOLN ST P.O. BOX 154
AUGUSTA WI
54722-9152
US

V. Phone/Fax

Practice location:
  • Phone: 715-225-1055
  • Fax: 715-286-5210
Mailing address:
  • Phone: 715-225-1055
  • Fax: 715-286-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: