Healthcare Provider Details

I. General information

NPI: 1396503231
Provider Name (Legal Business Name): ANDREW P HOLZLI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 UNIVERSITY AVE
MIDDLETON WI
53562-2764
US

IV. Provider business mailing address

105 CLARMAR DR
SUN PRAIRIE WI
53590-2675
US

V. Phone/Fax

Practice location:
  • Phone: 608-836-4542
  • Fax: 608-836-9672
Mailing address:
  • Phone: 608-318-5929
  • Fax: 608-318-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6168
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: