Healthcare Provider Details

I. General information

NPI: 1790953610
Provider Name (Legal Business Name): NATHAN STEVEN CUMMINGS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W RYAN ST
BRILLION WI
54110-1045
US

IV. Provider business mailing address

708 W RYAN ST
BRILLION WI
54110-1045
US

V. Phone/Fax

Practice location:
  • Phone: 920-756-2151
  • Fax: 920-756-3434
Mailing address:
  • Phone: 920-756-2151
  • Fax: 920-756-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5032-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: