Provider Demographics
NPI:1497814222
Name:NIEDERMANN, KARL A (DC)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:A
Last Name:NIEDERMANN
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 1:18215 TAYWOOD CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5685
Mailing Address - Country:US
Mailing Address - Phone:920-858-4580
Mailing Address - Fax:
Practice Address - Street 1:18215 TAYWOOD CIR APT 102
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5685
Practice Address - Country:US
Practice Address - Phone:920-858-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1803-12111N00000X
WI1803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70210Medicare PIN