Individual
DR. WALTER RUDOLPH WIESZTORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
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
3514-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005896742
AETNA
—
01
—
0191565
CIGNA
—
05
—
38911900
—
WI
01
—
4400259
UHC
—
01
—
521540114
MACS
—
01
—
721524922010
BLUE CROSS BLUE SHIELD
WI
Enumeration date
07/11/2005
Last updated
04/22/2008
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