Healthcare Provider Details

I. General information

NPI: 1164796579
Provider Name (Legal Business Name): JOE RICHARD SCOVELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH RICHARD SCOVELL DC

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N STATE HWY 35
DRESSER WI
54009-0186
US

IV. Provider business mailing address

PO BOX 186
DRESSER WI
54009-0186
US

V. Phone/Fax

Practice location:
  • Phone: 715-755-2583
  • Fax: 715-755-2573
Mailing address:
  • Phone: 715-755-2583
  • Fax: 715-755-2573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4832-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: