Healthcare Provider Details

I. General information

NPI: 1023181484
Provider Name (Legal Business Name): RONALD SCOTT NYEGGEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NORTH PIETY STREET
ELLSWORTH WI
54011-0335
US

IV. Provider business mailing address

PO BOX 335
ELLSWORTH WI
54011-0335
US

V. Phone/Fax

Practice location:
  • Phone: 715-273-4404
  • Fax: 715-273-4406
Mailing address:
  • Phone: 715-273-4404
  • Fax: 715-273-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1618
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: