Provider Demographics
NPI:1063574853
Name:HOFFMANN, WILLIAM ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALLEN
Last Name:HOFFMANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 PEMBROKE AVE S
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-1243
Mailing Address - Country:US
Mailing Address - Phone:651-565-4863
Mailing Address - Fax:651-565-4893
Practice Address - Street 1:176 PEMBROKE AVE S
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1243
Practice Address - Country:US
Practice Address - Phone:651-565-4863
Practice Address - Fax:651-565-4893
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2833111N00000X
WI2543-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39003800Medicaid
MN833598200Medicaid
WI000035511Medicare ID - Type UnspecifiedMEDICARE
WI39003800Medicaid
MN833598200Medicaid