Provider Demographics
NPI:1265844740
Name:WISSBROECKER, ANTHONY F (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:F
Last Name:WISSBROECKER
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 1:685 W BRIDGE ST STE 7
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2888
Mailing Address - Country:US
Mailing Address - Phone:507-413-8300
Mailing Address - Fax:507-413-8301
Practice Address - Street 1:685 W BRIDGE ST STE 7
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2888
Practice Address - Country:US
Practice Address - Phone:507-413-8300
Practice Address - Fax:507-413-8301
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor