Most Relevant Information
Provider Data
| NPI Number: | 1003814336 |
| Provider Name: | WALTER RUDOLPH WIESZTORT D.C. |
| Entity Type: | Individual |
| Taxonomy Code: | 111N00000X |
| Specialty: | Chiropractor |
| License Number: | 3514-012 |
Most Important Dates
| Enumeration Date: | 07/11/2005 |
| Last Updated: | 04/22/2008 |
Provider Practice Location
4014 77TH ST
STE. 2
KENOSHA
WI
531424314
Practice Location Phone/Fax
| Phone: | 2626943530 |
| Fax: | 2629258810 |
Provider Mailing Location
4014 77TH ST
STE. 2
KENOSHA
WI
531424314
Provider Mailing Phone/Fax
| Phone: | 2626943530 |
| Fax: | 2629258810 |