Provider Demographics
NPI:1043329741
Name:CZELATDKO, DANIEL E (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:CZELATDKO
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:E8475 W MALLARD RD
Mailing Address - Street 2:
Mailing Address - City:STRUM
Mailing Address - State:WI
Mailing Address - Zip Code:54770-5401
Mailing Address - Country:US
Mailing Address - Phone:715-833-8777
Mailing Address - Fax:715-833-8774
Practice Address - Street 1:3814 OAKWOOD HILLS PKWY
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7757
Practice Address - Country:US
Practice Address - Phone:715-833-8777
Practice Address - Fax:715-833-8774
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2840111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38863400Medicaid
WIU31222Medicare UPIN
WI70201Medicare ID - Type Unspecified