Provider Demographics
NPI:1710986096
Name:KROLL, CHRISTOPHER JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:KROLL
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 1:125A E PINE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1103
Mailing Address - Country:US
Mailing Address - Phone:920-648-6466
Mailing Address - Fax:920-648-4365
Practice Address - Street 1:125A E PINE ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1103
Practice Address - Country:US
Practice Address - Phone:920-648-6466
Practice Address - Fax:920-648-4365
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38943200Medicaid
WI391929487018OtherBC/BS
WIU71036Medicare UPIN
WI000230146Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID#