Provider Demographics
NPI:1235181975
Name:KIRCHBERG, JOEL DAVID (DC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:DAVID
Last Name:KIRCHBERG
Suffix:
Gender:M
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:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-0326
Mailing Address - Country:US
Mailing Address - Phone:920-623-2610
Mailing Address - Fax:920-623-2504
Practice Address - Street 1:1235 PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-1612
Practice Address - Country:US
Practice Address - Phone:920-623-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3989-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor