Provider Demographics
NPI:1558400499
Name:JUNGENBERG, JAMES LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:JUNGENBERG
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 1:1650 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-6914
Mailing Address - Country:US
Mailing Address - Phone:920-231-3700
Mailing Address - Fax:920-231-3859
Practice Address - Street 1:1650 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6914
Practice Address - Country:US
Practice Address - Phone:920-231-3700
Practice Address - Fax:920-231-3859
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1668-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI350000340OtherRAILROAD MEDICARE
WI38769300Medicaid
WI38769300Medicaid
WIT62360Medicare UPIN
WI350000340OtherRAILROAD MEDICARE