Provider Demographics
NPI:1174578942
Name:PFAU, DONALD JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOSEPH
Last Name:PFAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1463
Mailing Address - Country:US
Mailing Address - Phone:608-370-7328
Mailing Address - Fax:608-370-7329
Practice Address - Street 1:620 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1463
Practice Address - Country:US
Practice Address - Phone:608-370-7328
Practice Address - Fax:608-237-3119
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4222-012111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38968000Medicaid
WI00235953Medicare PIN