Provider Demographics
NPI:1124056213
Name:WIANECKI, KEVIN S (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:WIANECKI
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 1:786 OAK RD
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-8044
Mailing Address - Country:US
Mailing Address - Phone:715-693-3170
Mailing Address - Fax:
Practice Address - Street 1:2290 COUNTY HIGHWAY X
Practice Address - Street 2:SUITE B
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455
Practice Address - Country:US
Practice Address - Phone:715-693-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3593-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor