Individual
GLENN R WYSOCKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
7537 22ND AVENUE, KENOSHA, WI 53143-5701
(262) 652-3100
(262) 652-3100
Mailing address
7537 22ND AVENUE, KENOSHA, WI 53143-5701
(262) 652-3100
(262) 652-3100
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
1512
WI
111NX0800X
Orthopedic Chiropractor
Primary
1512
WI
Other
Enumeration date
02/27/2007
Last updated
12/09/2011
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