Provider Demographics
NPI:1245346543
Name:ZIEGLER, TERRY R (DC)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:R
Last Name:ZIEGLER
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 1:1777 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-2077
Mailing Address - Country:US
Mailing Address - Phone:262-284-3456
Mailing Address - Fax:262-268-6633
Practice Address - Street 1:1777 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-2077
Practice Address - Country:US
Practice Address - Phone:262-284-3456
Practice Address - Fax:262-268-6633
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38785000Medicaid
T63746Medicare UPIN
WI70615-0002Medicare ID - Type Unspecified