Provider Demographics
NPI:1235285099
Name:BAWEK, ANTHONY J (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:BAWEK
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 1:305 S DETTLOFF DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:WI
Mailing Address - Zip Code:54612-1702
Mailing Address - Country:US
Mailing Address - Phone:608-323-7651
Mailing Address - Fax:608-323-7651
Practice Address - Street 1:305 S DETTLOFF DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:WI
Practice Address - Zip Code:54612-1702
Practice Address - Country:US
Practice Address - Phone:608-323-7651
Practice Address - Fax:608-323-7651
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4282-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38993500OtherMEDICAID GROUP
WI38973800Medicaid
V11572Medicare UPIN
WI38973800Medicaid
WI000335370Medicare PIN