Provider Demographics
NPI:1558439984
Name:FENSKE, NICOLE KAY CRAWFORD (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KAY CRAWFORD
Last Name:FENSKE
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 1:7702 TERRACE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3285
Mailing Address - Country:US
Mailing Address - Phone:608-836-8883
Mailing Address - Fax:608-836-8863
Practice Address - Street 1:7702 TERRACE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3285
Practice Address - Country:US
Practice Address - Phone:608-836-8883
Practice Address - Fax:608-836-8863
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3548-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU83036Medicare UPIN