Provider Demographics
NPI:1417092909
Name:KRIESER FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:KRIESER FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRIESER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-563-1000
Mailing Address - Street 1:W330N4339 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:NASHOTAH
Mailing Address - State:WI
Mailing Address - Zip Code:53058-9798
Mailing Address - Country:US
Mailing Address - Phone:262-563-1000
Mailing Address - Fax:262-563-1200
Practice Address - Street 1:W330N4339 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:NASHOTAH
Practice Address - State:WI
Practice Address - Zip Code:53058-9798
Practice Address - Country:US
Practice Address - Phone:262-563-1000
Practice Address - Fax:262-563-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4167-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38967400Medicaid
WI000035831Medicare ID - Type Unspecified