Provider Demographics
NPI:1376636878
Name:SEVERSON, DENNIS EUGENE (DC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:EUGENE
Last Name:SEVERSON
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 1:154 W LINCOLN ST
Mailing Address - Street 2:P.O. BOX 154
Mailing Address - City:AUGUSTA
Mailing Address - State:WI
Mailing Address - Zip Code:54722-9152
Mailing Address - Country:US
Mailing Address - Phone:715-225-1055
Mailing Address - Fax:715-286-5210
Practice Address - Street 1:154 W LINCOLN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:AUGUSTA
Practice Address - State:WI
Practice Address - Zip Code:54722-9152
Practice Address - Country:US
Practice Address - Phone:715-225-1055
Practice Address - Fax:715-286-5210
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38790300Medicaid
WI391535721014OtherMY BC/BS
WI391535721014OtherMY BC/BS
WIT63310Medicare UPIN