Provider Demographics
NPI:1407059223
Name:TRUHLSEN, DWAYNE KEITH (DC)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:KEITH
Last Name:TRUHLSEN
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 186
Mailing Address - Street 2:
Mailing Address - City:DRESSER
Mailing Address - State:WI
Mailing Address - Zip Code:54009-0186
Mailing Address - Country:US
Mailing Address - Phone:715-755-2583
Mailing Address - Fax:715-175-5257
Practice Address - Street 1:115 N STATE HWY 35
Practice Address - Street 2:
Practice Address - City:DRESSER
Practice Address - State:WI
Practice Address - Zip Code:54009
Practice Address - Country:US
Practice Address - Phone:715-755-2583
Practice Address - Fax:715-755-2573
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38905900Medicaid
WI70645Medicare ID - Type Unspecified