Provider Demographics
NPI:1770525958
Name:NEMETZ, MARK CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:NEMETZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17550 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2928
Mailing Address - Country:US
Mailing Address - Phone:262-782-2273
Mailing Address - Fax:262-782-6946
Practice Address - Street 1:17550 W BLUEMOUND RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2928
Practice Address - Country:US
Practice Address - Phone:262-782-2273
Practice Address - Fax:262-782-6946
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3397-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38950000Medicaid
604939200OtherWORK COMP
WI38950000Medicaid
604939200OtherWORK COMP