MEDICARE: APPLIED KHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3111	WI

General Provider Information

NPI Number	:	1326101783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLIED KHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1281 BROSIG ST
Second Line	:	SUITE B
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1281 BROSIG ST
Second Line	:	SUITE B
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5303
Country	:	US
Telephone Number	:	920-965-0441
Fax Number	:

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. KURT WIPPERFURTH
Credential	:	D.C.
Telephone Number	:	920-965-0441

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/22/2020

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