Provider Demographics
NPI:1275287013
Name:GENRICH, DUSTIN R (DC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:R
Last Name:GENRICH
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 1:503 S CHERRY AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-4276
Mailing Address - Country:US
Mailing Address - Phone:715-898-1050
Mailing Address - Fax:715-384-6992
Practice Address - Street 1:503 S CHERRY AVE STE 3
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4276
Practice Address - Country:US
Practice Address - Phone:715-898-1050
Practice Address - Fax:715-384-6992
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor