Provider Demographics
NPI:1437264637
Name:HAUSMANN, MOLLY S (DC)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:S
Last Name:HAUSMANN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 W BARNARD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11203 N BUNTROCK AVE STE 100
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-1857
Practice Address - Country:US
Practice Address - Phone:262-512-1661
Practice Address - Fax:262-512-1663
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4239-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIV09839Medicare UPIN