Provider Demographics
NPI:1568922045
Name:NIELSEN, KATELYN ELAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:ELAINE
Last Name:NIELSEN
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:N56W39325 WISCONSIN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2192
Mailing Address - Country:US
Mailing Address - Phone:920-266-5008
Mailing Address - Fax:
Practice Address - Street 1:N56W39325 WISCONSIN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2192
Practice Address - Country:US
Practice Address - Phone:920-266-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5429-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor