Provider Demographics
NPI:1700926854
Name:VANDECASTLE, DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:VANDECASTLE
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:MARKESAN
Mailing Address - State:WI
Mailing Address - Zip Code:53946-0002
Mailing Address - Country:US
Mailing Address - Phone:920-398-1999
Mailing Address - Fax:920-398-1999
Practice Address - Street 1:77 W JOHN STREET
Practice Address - Street 2:
Practice Address - City:MARKESAN
Practice Address - State:WI
Practice Address - Zip Code:53946
Practice Address - Country:US
Practice Address - Phone:920-398-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3430OtherLICENSE NUMBER
WI70725Medicare ID - Type UnspecifiedMEDICARE NUMBER