Bayside Chiropractic LLC
Organization Active NPI Chiropractor · De Pere, WI
NPI 1659709376 · NPPES record last updated May 28, 2020
Key facts
- NPI
- 1659709376
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4214-012 (WI)
- Legal business name
- BAYSIDE CHIROPRACTIC LLC
- Practice address
- 1700 Sand Acres Dr Ste 2a
De Pere, WI 54115-7562 - Phone
- (920) 591-0141
- NPI assigned
- Oct 15, 2013
- Organization subpart
- No
Authorized official
- Name
- Connon Lee Piencikowski
- Title
- Chiropractor
- Phone
- (920) 591-0141
National Provider Directory
Locations
1700 Sand Acres Dr
Ste 2A
De Pere, WI 54115
Phone (920) 309-6658
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4214-012 | WI | Yes |
Addresses
Primary practice location
1700 Sand Acres Dr Ste 2a
De Pere, WI 54115-7562
Mailing address
1700 Sand Acres Dr Ste 2a
De Pere, WI 54115-7562
Phone (920) 591-0141
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| K100119441 | Other | WI | PTAN |
Other providers in De Pere, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.