Provider Demographics
NPI:1306834130
Name:WEHKING, BRADLEY H (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:H
Last Name:WEHKING
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 1:816 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-3608
Mailing Address - Country:US
Mailing Address - Phone:920-262-0200
Mailing Address - Fax:920-262-0210
Practice Address - Street 1:816 WEST ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3608
Practice Address - Country:US
Practice Address - Phone:920-262-0200
Practice Address - Fax:920-262-0210
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU53658Medicare UPIN
WI000235820Medicare ID - Type Unspecified