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General NPI Number Information
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NPI Number | 1487795084
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Entity Type | Organization
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Legal Business Name | WACKER CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 430 W UNION ST STE 2
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City | RICHLAND CENTER
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State | WI
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Zip | 53581-2220
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Country | US
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Telephone | 608-647-9100
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Fax | 608-647-9001
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Provider Business Mailing Address
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Address Line | 186 E MILL ST
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City | RICHLAND CENTER
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State | WI
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Zip | 53581-2241
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Country | US
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Telephone | 608-647-9100
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Fax | 608-647-9001
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Authorized Official
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Title or Position | OWNER
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Name | DR. DARYL R WACKER
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Credential | D.C.
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Telephone | 608-647-9100
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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 | 3695-012
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License Number State | WI
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