Healthcare Provider Details

I. General information

NPI: 1376605576
Provider Name (Legal Business Name): CHRISTOPHER L GILGE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 ROBIN LN
WAUSAU WI
54401-7158
US

IV. Provider business mailing address

151515 ROBIN LN
WAUSAU WI
54401-6645
US

V. Phone/Fax

Practice location:
  • Phone: 715-845-3775
  • Fax: 715-848-9015
Mailing address:
  • Phone: 715-845-3775
  • Fax: 715-848-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3814
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: