Provider Demographics
NPI:1427012186
Name:BIRKETT, STEVEN ALAN (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALAN
Last Name:BIRKETT
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 1:990 LINCOLN AVE
Mailing Address - Street 2:PO BOX 68
Mailing Address - City:FENNIMORE
Mailing Address - State:WI
Mailing Address - Zip Code:53809-1742
Mailing Address - Country:US
Mailing Address - Phone:608-822-3260
Mailing Address - Fax:608-822-3261
Practice Address - Street 1:990 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FENNIMORE
Practice Address - State:WI
Practice Address - Zip Code:53809-1742
Practice Address - Country:US
Practice Address - Phone:608-822-3260
Practice Address - Fax:608-822-3261
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3022-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI00008888900Medicaid
WI00008888900Medicaid
WI70875Medicare ID - Type Unspecified