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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