Provider Demographics
NPI:1063503316
Name:DRAGOSH, ANTHONY JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:DRAGOSH
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 1:141 W WISCONSIN AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-2123
Mailing Address - Country:US
Mailing Address - Phone:920-766-3741
Mailing Address - Fax:920-759-5050
Practice Address - Street 1:141 W WISCONSIN AVE
Practice Address - Street 2:STE 3
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-2123
Practice Address - Country:US
Practice Address - Phone:920-766-3741
Practice Address - Fax:920-766-5050
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000175500Medicare ID - Type Unspecified