Provider Demographics
NPI:1346681343
Name:GUDENSCHWAGER, ANDREW JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:GUDENSCHWAGER
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 1:550 W MAPLE ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1166
Mailing Address - Country:US
Mailing Address - Phone:608-355-4100
Mailing Address - Fax:608-355-4107
Practice Address - Street 1:550 W MAPLE ST
Practice Address - Street 2:SUITE #201
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1166
Practice Address - Country:US
Practice Address - Phone:608-355-4100
Practice Address - Fax:608-355-4107
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4933-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100030884Medicaid