Provider Demographics
NPI:1598354649
Name:DAWALT, GUY (DC)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:
Last Name:DAWALT
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 1:637 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUXEMBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54217-1125
Mailing Address - Country:US
Mailing Address - Phone:920-845-5654
Mailing Address - Fax:920-845-5640
Practice Address - Street 1:637 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUXEMBURG
Practice Address - State:WI
Practice Address - Zip Code:54217-1125
Practice Address - Country:US
Practice Address - Phone:920-845-5654
Practice Address - Fax:920-845-5640
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5600-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor