Healthcare Provider Details

I. General information

NPI: 1154082097
Provider Name (Legal Business Name): D&D CHIROPRACTIC AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 HIGH ST # 5B
WRIGHTSTOWN WI
54180-1253
US

IV. Provider business mailing address

444 JANET LN
WRIGHTSTOWN WI
54180-1158
US

V. Phone/Fax

Practice location:
  • Phone: 920-532-9071
  • Fax:
Mailing address:
  • Phone: 920-265-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAWN CRAFT
Title or Position: DR.
Credential: DC
Phone: 920-532-9071