Healthcare Provider Details

I. General information

NPI: 1063629509
Provider Name (Legal Business Name): PAUL HERMANN GASCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/18/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 RIDERS CLUB RD
ONALASKA WI
54650-2079
US

IV. Provider business mailing address

925 13TH AVE S STE 100
ONALASKA WI
54650-3417
US

V. Phone/Fax

Practice location:
  • Phone: 608-519-8112
  • Fax: 608-519-8113
Mailing address:
  • Phone: 608-519-8112
  • Fax: 608-519-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4965-12
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number761-0406
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: