Provider Demographics
NPI:1720167521
Name:PRESTON, CHAD W (DC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:W
Last Name:PRESTON
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 1:396 RED CEDAR STREET
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2386
Mailing Address - Country:US
Mailing Address - Phone:715-235-5800
Mailing Address - Fax:715-235-0571
Practice Address - Street 1:396 RED CEDAR STREET
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2386
Practice Address - Country:US
Practice Address - Phone:715-235-5800
Practice Address - Fax:715-235-0571
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T63032Medicare UPIN