Organization
VANDECASTLE FAMILY CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK JAMES VANDECASTLE D.C. (OWNER)
(920) 787-0122
Entity
Organization
Contact information
Practice address
140 N. TOWNLINE RD, WAUTOMA, WI 54982-0512
(920) 787-0122
(920) 787-0091
Mailing address
PO BOX 512, WAUTOMA, WI 54982-0512
(920) 787-0122
(920) 787-0091
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
3211-12
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38885200
—
WI
Enumeration date
07/24/2013
Last updated
07/24/2013
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