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General NPI Number Information
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NPI Number | 1043332299
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Entity Type | Organization
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Legal Business Name | VANDECASTLE FAMILY CHIROPRACTIC CLINIC,LLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 77 W. JOHN ST.
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City | MARKESAN
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State | WI
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Zip | 53946
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Country | US
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Telephone | 920-398-1999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2
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City | MARKESAN
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State | WI
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Zip | 53946-0002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAWN VANDECASTLE
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Credential | D.C.
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Telephone | 920-398-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3430
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License Number State | WI
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