Provider Demographics
NPI:1558337568
Name:KIRCHBERG, TIMOTHY C (DC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:C
Last Name:KIRCHBERG
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 1:1235 PARK AVE
Mailing Address - Street 2:PO 326
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1612
Mailing Address - Country:US
Mailing Address - Phone:920-623-2610
Mailing Address - Fax:920-623-2504
Practice Address - Street 1:1235 PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-1612
Practice Address - Country:US
Practice Address - Phone:920-623-2610
Practice Address - Fax:920-623-2504
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI544551OtherDEANCARE INS PROVIDER
WI391842730015OtherBCBS INS PROVIDER
WI38873000Medicaid
WIU43434Medicare UPIN
WI544551OtherDEANCARE INS PROVIDER