Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4272-012 | WI |
NPI | 1003955808 |
---|---|
Provider Name | Dr. Ryan Michael Hetzel |
First Address | Brookfield, WI 53045-3469 |
Second Address | Waukesha, WI 53186-1429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |