Individual
DR. LEO RAYMOND GONSOWSKI III
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DC, CSCS
Contact information
Practice address
471 S ARCH AVE, NEW RICHMOND, WI 54017-1832
(715) 246-5600
(715) 246-5806
Mailing address
471 S ARCH AVE, NEW RICHMOND, WI 54017-1832
(715) 246-5600
(715) 246-5806
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
3847-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2C933GO
BLUE CROSS & BLUE SHIELD
MN
01
—
666234
CHIROCARE WISCONSIN
WI
Enumeration date
10/11/2005
Last updated
07/08/2007
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