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General NPI Number Information
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NPI Number | 1699081224
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Entity Type | Individual
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Provider Name | CHAD GREGORY UPDIKE D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 525 MCHUGH RD
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City | HOLMEN
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State | WI
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Zip | 54636-9256
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Country | US
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Telephone | 608-526-2854
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Fax | 608-526-1414
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Provider Business Mailing Address
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Address Line | 204 S CENTURY AVE
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City | WAUNAKEE
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State | WI
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Zip | 53597-1272
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Country | US
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Telephone | 608-849-4464
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Fax | 608-849-4428
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4651-012
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License Number State | WI
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