Provider Demographics
NPI:1093860702
Name:GRESS-VOLPENTESTA, KATHERINE M (DC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:GRESS-VOLPENTESTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 A S CENTER AVE.
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452
Mailing Address - Country:US
Mailing Address - Phone:715-539-9797
Mailing Address - Fax:715-539-9098
Practice Address - Street 1:109 A S CENTER AVE
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452
Practice Address - Country:US
Practice Address - Phone:715-539-9797
Practice Address - Fax:715-539-9098
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3550-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035146OtherMEDICARE GROUP PROVIDER NO.
WI000035146OtherMEDICARE GROUP PROVIDER NO.
WIU73590Medicare UPIN