Provider Demographics
NPI:1114973997
Name:CASEY, MONICA RUTH (DC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RUTH
Last Name:CASEY
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 1:7639 W BELOIT RD
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2447
Mailing Address - Country:US
Mailing Address - Phone:414-377-0560
Mailing Address - Fax:414-377-0546
Practice Address - Street 1:7639 W BELOIT RD
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-2447
Practice Address - Country:US
Practice Address - Phone:414-543-1951
Practice Address - Fax:414-543-1595
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3570-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI201921282018OtherBLUE CROSS
WI38924600Medicaid
WI35678Medicare ID - Type Unspecified
WI38924600Medicaid