Healthcare Provider Details

I. General information

NPI: 1750455135
Provider Name (Legal Business Name): EDWARD V FLESCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 W MAIN ST
BELLEVILLE WI
53508
US

IV. Provider business mailing address

PO BOX 235
BELLEVILLE WI
53508-0235
US

V. Phone/Fax

Practice location:
  • Phone: 608-424-6525
  • Fax:
Mailing address:
  • Phone: 608-424-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3017-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: