Healthcare Provider Details

I. General information

NPI: 1124946322
Provider Name (Legal Business Name): MYCHALA R SPANG DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 NYGAARD ST
STOUGHTON WI
53589-5418
US

IV. Provider business mailing address

105 CLARMAR DR
SUN PRAIRIE WI
53590-2675
US

V. Phone/Fax

Practice location:
  • Phone: 608-480-7103
  • Fax: 608-480-7141
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 Number6417-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: