Healthcare Provider Details

I. General information

NPI: 1588820419
Provider Name (Legal Business Name): WYSS CLINIC OF CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 CURRY CT SUITE #2
GREEN BAY WI
54311-4877
US

IV. Provider business mailing address

2830 CURRY CT SUITE #2
GREEN BAY WI
54311-4877
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-4199
  • Fax:
Mailing address:
  • Phone: 920-468-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4413-012
License Number StateWI

VIII. Authorized Official

Name: DR. SKIP R WYSS
Title or Position: MEMBER
Credential: D.C
Phone: 715-896-3023