Provider Demographics
NPI:1699836718
Name:ZILISCH, DON RAYMOND (DC)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:RAYMOND
Last Name:ZILISCH
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 1:1801 CROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-3245
Mailing Address - Country:US
Mailing Address - Phone:920-766-9411
Mailing Address - Fax:920-766-9412
Practice Address - Street 1:1801 CROOKS AVE
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-3245
Practice Address - Country:US
Practice Address - Phone:920-766-9411
Practice Address - Fax:920-766-9412
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38897600Medicaid
WI70770Medicare ID - Type Unspecified
WI38897600Medicaid