Provider Demographics
NPI:1114162351
Name:AZINGER, JOAN R (LAC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:R
Last Name:AZINGER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JORI
Other - Middle Name:
Other - Last Name:AZINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:163 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1603
Mailing Address - Country:US
Mailing Address - Phone:262-242-6521
Mailing Address - Fax:262-242-6521
Practice Address - Street 1:163 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1603
Practice Address - Country:US
Practice Address - Phone:262-242-6521
Practice Address - Fax:262-242-6521
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI350-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI350-055OtherACUPUNCTURE LICENSE