Healthcare Provider Details

I. General information

NPI: 1750455887
Provider Name (Legal Business Name): ANTHONY JAMES OTTO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W MASON ST
GREEN BAY WI
54303-4838
US

IV. Provider business mailing address

300 PACKERLAND DR UNIT 10911
GREEN BAY WI
54307-4232
US

V. Phone/Fax

Practice location:
  • Phone: 920-429-2844
  • Fax: 920-429-2845
Mailing address:
  • Phone: 262-219-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4315-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: