Doctor Name: | DR. WALTER RUDOLPH WIESZTORT |
NPI Number: | 1003814336 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.C. |
License Number: | 3514-012 |
Business Practice Address: | 4014 77th St Ste. 2 Kenosha, WI - 531424314 |
Business Phone Number: | 2626943530 |
Business Fax Number: | 2629258810 |
Mailing Address: | 4014 77th St, Ste. 2 KENOSHA |
State: | WI |
Postal Code: | 531424314 |
Phone Number: | 2626943530 |
Fax Number: | 2629258810 |
NPI Enumeration Date: | 07/11/2005 |
NPI Last Update Date: | 04/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | 03/16/2006 |
NPI Reactivation Date: | 03/24/2006 |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 3514-012 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |