Individual
DR. JOHN B. DIETRICH II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1105 W GRAND AVE, WISCONSIN RAPIDS, WI 54495-3349
(715) 423-4050
(715) 424-3108
Mailing address
1105 W GRAND AVE, WISCONSIN RAPIDS, WI 54495-3349
(715) 423-4050
(715) 424-3108
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3621-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38922000
—
WI
Enumeration date
01/22/2007
Last updated
07/08/2007
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