Provider Demographics
NPI:1194032375
Name:YELLOW WOOD CHIROPRACTIC
Entity Type:Organization
Organization Name:YELLOW WOOD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRADER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-205-0711
Mailing Address - Street 1:5497 WATERFORD LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8509
Mailing Address - Country:US
Mailing Address - Phone:920-202-5741
Mailing Address - Fax:920-569-2951
Practice Address - Street 1:5497 WATERFORD LN
Practice Address - Street 2:SUITE D
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8509
Practice Address - Country:US
Practice Address - Phone:920-202-5741
Practice Address - Fax:920-569-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4622-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty