Provider Demographics
NPI:1447242193
Name:TOWNE, KELLY J (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:TOWNE
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 396
Mailing Address - Street 2:
Mailing Address - City:NEW GLARUS
Mailing Address - State:WI
Mailing Address - Zip Code:53574-0396
Mailing Address - Country:US
Mailing Address - Phone:608-527-2715
Mailing Address - Fax:608-527-5796
Practice Address - Street 1:700 HWY 69 SOUTH
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-0396
Practice Address - Country:US
Practice Address - Phone:608-527-2715
Practice Address - Fax:608-527-5796
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38851500Medicaid
WI38851500Medicaid
WIU09945Medicare UPIN