MEDICARE: WIANECKI CHIROPRACTIC, L.L.C.

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1336176841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WIANECKI CHIROPRACTIC, L.L.C.

Provider Business Mailing Address
First Line	:	2290 CTH X
Second Line	:	SUITE B
City	:	MOSINEE
State	:	WI
Zip	:	54455
Country	:	US
Telephone Number	:	715-693-3170
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 CTH X
Second Line	:	SUITE B
City	:	MOSINEE
State	:	WI
Zip	:	54455
Country	:	US
Telephone Number	:	715-693-3170
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. KEVIN S. WIANECKI
Credential	:	D.C.
Telephone Number	:	715-693-3170

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/22/2020

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