Individual
JON T WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
116 PINE ST, MAUSTON, WI 53948-1336
(608) 847-1888
(608) 847-1678
Mailing address
18669 INNSWOOD RD, NORWALK, WI 54648-7019
(608) 269-0585
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2233-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38801200
—
WI
Enumeration date
07/21/2006
Last updated
07/09/2007
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