Provider Demographics
NPI:1427702869
Name:SCHEPPKE, LOGAN P
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:P
Last Name:SCHEPPKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 LORCH AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-9191
Mailing Address - Country:US
Mailing Address - Phone:715-895-8436
Mailing Address - Fax:
Practice Address - Street 1:3225 LORCH AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-9191
Practice Address - Country:US
Practice Address - Phone:715-895-8436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5684-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor