Healthcare Provider Details

I. General information

NPI: 1154822047
Provider Name (Legal Business Name): CHYANN WEGNER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 LATTON LN STE A
PORTAGE WI
53901-1078
US

IV. Provider business mailing address

1101 WAUONA TRL
PORTAGE WI
53901-1407
US

V. Phone/Fax

Practice location:
  • Phone: 608-742-1300
  • Fax:
Mailing address:
  • Phone: 608-575-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6289-12
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: