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Organization
WIESZTORT FAMILY CHIROPRACTIC CLINIC, S.C.
Active
Organization
WIESZTORT FAMILY CHIROPRACTIC CLINIC, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER RUDOLPH WIESZTORT D.C. (PRESIDENT)
(262) 694-3530
Entity
Organization
Contact information
Practice address
4014 77TH ST STE 2, KENOSHA, WI 53142-4314
(262) 694-3530
(262) 925-8810
Mailing address
4014 77TH ST STE 2, KENOSHA, WI 53142-4314
(262) 694-3530
(262) 925-8810
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3514
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38911900
—
WI
Enumeration date
11/14/2006
Last updated
04/22/2008
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