Healthcare Provider Details

I. General information

NPI: 1932317096
Provider Name (Legal Business Name): SCOTT HAROLD WRUCK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 HANSEN RD STE F
GREEN BAY WI
54304-5376
US

IV. Provider business mailing address

940 HANSEN RD STE F
GREEN BAY WI
54304-5376
US

V. Phone/Fax

Practice location:
  • Phone: 920-494-6211
  • Fax: 920-494-6219
Mailing address:
  • Phone: 920-494-6211
  • Fax: 920-494-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number3434
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: