Provider Demographics
NPI:1467259531
Name:WOMBACHER, AUSTIN (DC)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:WOMBACHER
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10853 RIESS ROAD
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258
Mailing Address - Country:US
Mailing Address - Phone:618-980-4056
Mailing Address - Fax:
Practice Address - Street 1:13 SOUTH MAIN STREET STE. 3
Practice Address - Street 2:
Practice Address - City:SMITHTON
Practice Address - State:IL
Practice Address - Zip Code:62285
Practice Address - Country:US
Practice Address - Phone:618-408-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.014244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty