Provider Demographics
NPI:1376612184
Name:SZYMANSKI, THEODORE DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:DONALD
Last Name:SZYMANSKI
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:PO BOX 5208
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-5208
Mailing Address - Country:US
Mailing Address - Phone:920-231-8500
Mailing Address - Fax:920-231-1257
Practice Address - Street 1:309 N SAWYER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4252
Practice Address - Country:US
Practice Address - Phone:920-231-8500
Practice Address - Fax:920-231-1257
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3768-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38930800Medicaid
WI38930800Medicaid