Provider Demographics
NPI:1568424232
Name:LINNEMAN, PEGGY SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:SUE
Last Name:LINNEMAN
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 1:214 S. 2ND ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-2083
Mailing Address - Country:US
Mailing Address - Phone:262-472-0209
Mailing Address - Fax:262-472-0211
Practice Address - Street 1:214 S. 2ND ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-2083
Practice Address - Country:US
Practice Address - Phone:262-472-0209
Practice Address - Fax:262-472-0211
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3407-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38900000Medicaid
WI000035174Medicare UPIN