Provider Demographics
NPI:1477632008
Name:WASILENSKY, DONALD E (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:E
Last Name:WASILENSKY
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 1:7203 DRESSAGE DR
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2471
Mailing Address - Country:US
Mailing Address - Phone:218-764-2564
Mailing Address - Fax:218-764-2386
Practice Address - Street 1:302 E HOWARD ST
Practice Address - Street 2:SUITE 16
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1772
Practice Address - Country:US
Practice Address - Phone:218-262-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT63614Medicare UPIN