Provider Demographics
NPI:1629183918
Name:WITZKE-FROST, LISA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:WITZKE-FROST
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 1:1496 BELLEVUE ST STE 501
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-4251
Mailing Address - Country:US
Mailing Address - Phone:920-406-8861
Mailing Address - Fax:920-406-8863
Practice Address - Street 1:1496 BELLEVUE ST STE 501
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-4251
Practice Address - Country:US
Practice Address - Phone:920-406-8861
Practice Address - Fax:920-406-8863
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2748-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70341Medicare ID - Type Unspecified
WIU27549Medicare UPIN