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Individual

MR. TY C. WADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
620 E. GREEN BAY AVE., SUITE 104, SAUKVILLE, WI 53080
(262) 284-0022
(262) 268-0715
Mailing address
620 E. GREEN BAY AVE., SUITE 104, SAUKVILLE, WI 53080
(262) 284-0022
(262) 268-0715

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4012-012
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
202500022
UHC
WI
05
389-50300
WI
05
38950300
WI
01
649385
ACN
WI
Enumeration date
01/30/2007
Last updated
05/22/2024
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