Healthcare Provider Details

I. General information

NPI: 1811178759
Provider Name (Legal Business Name): ANNA MARIE BEDOGNE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIE FLINK D.C.

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 55TH ST
KENOSHA WI
53140-3753
US

IV. Provider business mailing address

505 S 6TH ST
ESCANABA MI
49829-3919
US

V. Phone/Fax

Practice location:
  • Phone: 262-657-8434
  • Fax:
Mailing address:
  • Phone: 906-399-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009354
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4453-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: