Provider Demographics
NPI:1790953610
Name:CUMMINGS, NATHAN STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:STEVEN
Last Name:CUMMINGS
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 1:708 W RYAN ST
Mailing Address - Street 2:
Mailing Address - City:BRILLION
Mailing Address - State:WI
Mailing Address - Zip Code:54110-1045
Mailing Address - Country:US
Mailing Address - Phone:920-756-2151
Mailing Address - Fax:920-756-3434
Practice Address - Street 1:708 W RYAN ST
Practice Address - Street 2:
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110-1045
Practice Address - Country:US
Practice Address - Phone:920-756-2151
Practice Address - Fax:920-756-3434
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5032-12111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100039599Medicaid
WIK400167323Medicare PIN