=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144366238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA DEHNERT D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 03/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15400 W CAPITOL DR SUITE 202
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53005-2661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-754-1211
-----------------------------------------------------
Fax | 262-754-2911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 825A S MAIN ST
-----------------------------------------------------
City | WEST BEND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53095-4633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-754-1211
-----------------------------------------------------
Fax | 262-754-2911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2404-012
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------