Organization
BAYSIDE CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONNON LEE PIENCIKOWSKI (CHIROPRACTOR)
(920) 591-0141
Entity
Organization
Contact information
Practice address
1700 SAND ACRES DR STE 2A, DE PERE, WI 54115-7562
(920) 591-0141
Mailing address
1700 SAND ACRES DR STE 2A, DE PERE, WI 54115-7562
(920) 591-0141
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4214-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K100119441
PTAN
WI
Enumeration date
10/15/2013
Last updated
05/28/2020
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