Provider Demographics
NPI:1366468761
Name:VARISH, WENDY LC (DC, FACO)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:LC
Last Name:VARISH
Suffix:
Gender:F
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14108 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:WI
Mailing Address - Zip Code:53015-1113
Mailing Address - Country:US
Mailing Address - Phone:920-565-4192
Mailing Address - Fax:
Practice Address - Street 1:516 S WISCONSIN DR
Practice Address - Street 2:
Practice Address - City:HOWARDS GROVE
Practice Address - State:WI
Practice Address - Zip Code:53083-1261
Practice Address - Country:US
Practice Address - Phone:920-565-3922
Practice Address - Fax:920-565-2142
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU37748Medicare UPIN