Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5217-12 | WI |
NPI | 1003368630 |
---|---|
Provider Name | Nathaniel Alan Drees |
First Address | Waupun, WI 53963-2276 |
Second Address | Waupun, WI 53963-2276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2016 |
Last Update Date | 14/02/2019 |