Provider Demographics
NPI:1487795084
Name:WACKER CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:WACKER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-647-9100
Mailing Address - Street 1:186 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2241
Mailing Address - Country:US
Mailing Address - Phone:608-647-9100
Mailing Address - Fax:608-647-9001
Practice Address - Street 1:430 W UNION ST STE 2
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2220
Practice Address - Country:US
Practice Address - Phone:608-647-9100
Practice Address - Fax:608-647-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3695-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU82816Medicare UPIN