Healthcare Provider Details

I. General information

NPI: 1801484050
Provider Name (Legal Business Name): WILLIAM HENRY ZIMMER-WAKELEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 10/05/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9719 E MAIN ST - UNIT 5
POPLAR WI
54864
US

IV. Provider business mailing address

1001 BELKNAP ST UNIT 203
SUPERIOR WI
54880-2823
US

V. Phone/Fax

Practice location:
  • Phone: 715-446-8438
  • Fax:
Mailing address:
  • Phone: 715-446-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5604-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: