Provider Demographics
NPI:1508915067
Name:RICHTER, CARRIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:RICHTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W COLUMBIAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3018
Mailing Address - Country:US
Mailing Address - Phone:920-969-1882
Mailing Address - Fax:920-886-3613
Practice Address - Street 1:116 W COLUMBIAN AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3018
Practice Address - Country:US
Practice Address - Phone:920-969-1882
Practice Address - Fax:920-886-3613
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3905012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38957100Medicaid
WI38957100Medicaid