Provider Demographics
NPI:1710964002
Name:WAIT, WENDY L (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L
Last Name:WAIT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W BELTLINE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2603
Mailing Address - Country:US
Mailing Address - Phone:608-255-7000
Mailing Address - Fax:
Practice Address - Street 1:301 W BELTLINE HWY STE 101
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-2603
Practice Address - Country:US
Practice Address - Phone:608-255-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3771-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU85208Medicare UPIN