Provider Demographics
NPI:1164599221
Name:FOLSTAD, CHERYL CERNAK (DC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:CERNAK
Last Name:FOLSTAD
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 1:1100 KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-2630
Mailing Address - Country:US
Mailing Address - Phone:608-343-5025
Mailing Address - Fax:608-372-3100
Practice Address - Street 1:1100 KILBOURN AVE
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-2630
Practice Address - Country:US
Practice Address - Phone:608-372-2747
Practice Address - Fax:608-372-3100
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1875-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391513385OtherFEDERAL TAX ID
WI000075472Medicare ID - Type Unspecified
WIT61925Medicare UPIN