Provider Demographics
NPI:1376908061
Name:APPLETON WELLNESS WAY LLC
Entity Type:Organization
Organization Name:APPLETON WELLNESS WAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-733-3371
Mailing Address - Street 1:1037 TRUMAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-2217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1037 TRUMAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-2217
Practice Address - Country:US
Practice Address - Phone:920-733-3371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4405-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty