Provider Demographics
NPI:1336176841
Name:WIANECKI CHIROPRACTIC, L.L.C.
Entity Type:Organization
Organization Name:WIANECKI CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WIANECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-693-3170
Mailing Address - Street 1:2290 CTH X
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455
Mailing Address - Country:US
Mailing Address - Phone:715-693-3170
Mailing Address - Fax:
Practice Address - Street 1:2290 CTH X
Practice Address - Street 2:SUITE B
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455
Practice Address - Country:US
Practice Address - Phone:715-693-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center