Provider Demographics
NPI:1275720062
Name:WENGER, JAMES CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CARL
Last Name:WENGER
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 1:4109 COUNTY ROAD CH
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-8603
Mailing Address - Country:US
Mailing Address - Phone:608-935-9255
Mailing Address - Fax:
Practice Address - Street 1:4109 COUNTY ROAD CH
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-8603
Practice Address - Country:US
Practice Address - Phone:608-935-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1809-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38778600Medicaid
75659Medicare PIN