Individual
RICHARD WOLCOTT KINGSBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC., LAT
Contact information
Practice address
721 CARDINAL LN, SUITE 100, GREEN BAY, WI 54313-3216
(920) 434-2221
Mailing address
121 VAN HECKE AVE, APT 38, OCONTO, WI 54153-9295
(815) 762-3155
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4972-12
WI
2255A2300X
Athletic Trainer
1436-39
WI
Other
Enumeration date
11/06/2013
Last updated
09/25/2014
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