Provider Demographics
NPI:1760728703
Name:HYDE, MAUREEN NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:NICOLE
Last Name:HYDE
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 1:2911 TOWER AVE
Mailing Address - Street 2:STE. # 4
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5585
Mailing Address - Country:US
Mailing Address - Phone:715-392-4883
Mailing Address - Fax:715-392-4873
Practice Address - Street 1:2911 TOWER AVE
Practice Address - Street 2:STE. # 4
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5585
Practice Address - Country:US
Practice Address - Phone:715-392-4883
Practice Address - Fax:715-392-4873
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4914-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor