Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2336-012 | WI |
NPI | 1114095007 |
---|---|
Provider Name | Dr. Carl Heigl |
First Address | Franklin, WI 53132-9099 |
Second Address | Franklin, WI 53132-9099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 10/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
76144192 | WAUSAU (01) | WI |