Provider Demographics
NPI:1720170715
Name:CHISICK, RICHARD STANLEY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STANLEY
Last Name:CHISICK
Suffix:JR
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:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WI
Mailing Address - Zip Code:54968-0312
Mailing Address - Country:US
Mailing Address - Phone:920-295-6741
Mailing Address - Fax:920-295-6742
Practice Address - Street 1:433 W WATER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WI
Practice Address - Zip Code:54968-9148
Practice Address - Country:US
Practice Address - Phone:920-295-6741
Practice Address - Fax:920-295-6742
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3222-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12400290OtherWPPN
WI38888800Medicaid