Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4965-12 | WI |
N | 111NN1001X | Nutrition | 761-0406 | NH |
NPI | 1063629509 |
---|---|
Provider Name | Mr. Paul Hermann Gasch |
First Address | Onalaska, WI 54650-3417 |
Second Address | Onalaska, WI 54650-2079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 18/10/2020 |