Healthcare Provider Details

I. General information

NPI: 1699872937
Provider Name (Legal Business Name): CHRISTOPHER N SEVERT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 KNAPP ST BOX 558
CHETEK WI
54728
US

IV. Provider business mailing address

601 S 32ND AVE
WAUSAU WI
54401-3958
US

V. Phone/Fax

Practice location:
  • Phone: 715-924-3510
  • Fax: 715-924-1848
Mailing address:
  • Phone: 715-848-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3477-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: