Provider Demographics
NPI:1215209283
Name:WACHTEL, NICHOLAS R (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:WACHTEL
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 1:218 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-1051
Mailing Address - Country:US
Mailing Address - Phone:715-623-5481
Mailing Address - Fax:
Practice Address - Street 1:2006 PROGRESS BLVD
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2475
Practice Address - Country:US
Practice Address - Phone:715-623-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4865-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor