Provider Demographics
NPI:1588055503
Name:BEMIS, WADE (DC)
Entity type:Individual
Prefix:DR
First Name:WADE
Middle Name:
Last Name:BEMIS
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:N1614 HWY 28
Mailing Address - Street 2:
Mailing Address - City:ADELL
Mailing Address - State:WI
Mailing Address - Zip Code:53001-1369
Mailing Address - Country:US
Mailing Address - Phone:920-889-0555
Mailing Address - Fax:
Practice Address - Street 1:220 S BUSINESS PARK DR
Practice Address - Street 2:UNIT A-7
Practice Address - City:OOSTBURG
Practice Address - State:WI
Practice Address - Zip Code:53070-1585
Practice Address - Country:US
Practice Address - Phone:920-564-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5062-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor