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3713 Calumet Ave Manitowoc WI 54220-5433 | |
(920) 682-6680 | |
(920) 682-6983 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3713 Calumet Ave, Manitowoc, Wisconsin |
Authorized Official Name and Position | Dean Allen Willhite (PRESIDENT) |
Authorized Official Contact | 9206826680 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3713 Calumet Ave Manitowoc WI 54220-5433 Ph: (920) 682-6680 | 3713 Calumet Ave Manitowoc WI 54220-5433 Ph: (920) 682-6680 |
NPI Number | 1447447222 |
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Provider Enumeration Date | 09/26/2007 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 3476542036 |
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Medicare Enrollment ID | O20040510000068 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447447222 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (Wisconsin) | Primary |
Provider Name | Dean A Willhite |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1053344168 PECOS PAC ID: 5193714756 Enrollment ID: I20040511000792 |
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