Provider Demographics
NPI:1588820419
Name:WYSS CLINIC OF CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WYSS CLINIC OF CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SKIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:WYSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-896-3023
Mailing Address - Street 1:2830 CURRY CT
Mailing Address - Street 2:SUITE #2
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-4877
Mailing Address - Country:US
Mailing Address - Phone:920-468-4199
Mailing Address - Fax:
Practice Address - Street 1:2830 CURRY CT
Practice Address - Street 2:SUITE #2
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-4877
Practice Address - Country:US
Practice Address - Phone:920-468-4199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4413-012261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center