Provider Demographics
NPI:1407196298
Name:COULEE HEALTH LLC
Entity Type:Organization
Organization Name:COULEE HEALTH LLC
Other - Org Name:COULEE HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-498-4669
Mailing Address - Street 1:920 W CITY HIGHWAY 16
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-1951
Mailing Address - Country:US
Mailing Address - Phone:608-498-4669
Mailing Address - Fax:608-807-5142
Practice Address - Street 1:920 W CITY HIGHWAY 16
Practice Address - Street 2:SUITE A
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1951
Practice Address - Country:US
Practice Address - Phone:608-498-4669
Practice Address - Fax:608-807-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4770012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1407196298OtherORGANIZATIONAL NPI
WI1407196298OtherORGANIZATIONAL NPI