Provider Demographics
NPI:1861418816
Name:WACKER, DARYL (DC)
Entity type:Individual
Prefix:DR
First Name:DARYL
Middle Name:
Last Name:WACKER
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 1:430 W UNION ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2220
Mailing Address - Country:US
Mailing Address - Phone:608-647-9100
Mailing Address - Fax:608-647-9001
Practice Address - Street 1:430 W UNION ST STE 2
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2220
Practice Address - Country:US
Practice Address - Phone:608-647-9100
Practice Address - Fax:608-647-9001
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3695-012111N00000X
WI3695-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU82816Medicare UPIN