Healthcare Provider Details

I. General information

NPI: 1548427024
Provider Name (Legal Business Name): PAPENDIECK CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 MAIN ST
NEENAH WI
54956-2254
US

IV. Provider business mailing address

835 MAIN ST
NEENAH WI
54956-2254
US

V. Phone/Fax

Practice location:
  • Phone: 920-886-1111
  • Fax: 920-727-1458
Mailing address:
  • Phone: 920-886-1111
  • Fax: 920-727-1458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number4405-12
License Number StateWI

VIII. Authorized Official

Name: ZACHARY P PAPENDIECK
Title or Position: SOLE MEMBER
Credential: D.C.
Phone: 920-886-1111