Provider Demographics
NPI:1063629509
Name:GASCH, PAUL HERMANN (DC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HERMANN
Last Name:GASCH
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 1:925 13TH AVE S
Mailing Address - Street 2:STE 100
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-3417
Mailing Address - Country:US
Mailing Address - Phone:608-519-8112
Mailing Address - Fax:608-519-8113
Practice Address - Street 1:1115 RIDERS CLUB RD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2079
Practice Address - Country:US
Practice Address - Phone:608-519-8112
Practice Address - Fax:608-519-8113
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4965-12111N00000X
NH761-0406111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
000973101Medicare PIN