Provider Demographics
NPI:1568076081
Name:WENZEL, DYLAN ROY (DC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:ROY
Last Name:WENZEL
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 1:11880 VELP AVE STE F
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-7881
Mailing Address - Country:US
Mailing Address - Phone:920-857-3126
Mailing Address - Fax:
Practice Address - Street 1:11880 VELP AVE STE F
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-7881
Practice Address - Country:US
Practice Address - Phone:920-857-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5559-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor