MEDICARE: DR. DONALD E. WASILENSKY D.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	111N00000X	Chiropractor	1312	MN

General Provider Information

NPI Number	:	1477632008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD E. WASILENSKY D.C.

Provider Business Mailing Address
First Line	:	7203 DRESSAGE DR
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-2471
Country	:	US
Telephone Number	:	218-764-2564
Fax Number	:	218-764-2386

Provider Business Practice Location Address
First Line	:	302 E HOWARD ST
Second Line	:	SUITE 16
City	:	HIBBING
State	:	MN
Zip	:	55746-1772
Country	:	US
Telephone Number	:	218-262-4911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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