Provider Demographics
NPI:1699836213
Name:KROMREY, SHAWN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:KROMREY
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 1:500 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CADOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54727-9401
Mailing Address - Country:US
Mailing Address - Phone:715-289-5000
Mailing Address - Fax:715-289-3388
Practice Address - Street 1:500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CADOTT
Practice Address - State:WI
Practice Address - Zip Code:54727-9401
Practice Address - Country:US
Practice Address - Phone:715-289-5000
Practice Address - Fax:715-289-3388
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000135679OtherMEDICARE INDIVIDUAL
WI39000500Medicaid
WI000135679OtherMEDICARE INDIVIDUAL