=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740426477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ANDREA APPLETON LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2008
-----------------------------------------------------
Last Update Date | 12/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1431 W MASON ST
-----------------------------------------------------
City | GREEN BAY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54303-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-405-0050
-----------------------------------------------------
Fax | 920-405-0553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1431 W MASON ST
-----------------------------------------------------
City | GREEN BAY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54303-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-405-0050
-----------------------------------------------------
Fax | 920-405-0553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANDREA MARIE WOCHENSKE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 920-405-0050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4086
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------