Provider Demographics
NPI:1669814653
Name:AUGUSTINE, DAVID DONALD JOSEPH
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DONALD JOSEPH
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:DONALD JOSEPH
Other - Last Name:AUGUSTINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1210 S KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-6170
Mailing Address - Country:US
Mailing Address - Phone:920-235-0000
Mailing Address - Fax:920-235-3522
Practice Address - Street 1:1210 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6170
Practice Address - Country:US
Practice Address - Phone:920-235-0000
Practice Address - Fax:920-235-3522
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5804111N00000X
WI5293-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor