Provider Demographics
NPI:1760612295
Name:KRISIK, AARON J (DC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:J
Last Name:KRISIK
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 1:3011 S MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8710
Mailing Address - Country:US
Mailing Address - Phone:715-234-6338
Mailing Address - Fax:715-234-8364
Practice Address - Street 1:3011 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8710
Practice Address - Country:US
Practice Address - Phone:715-234-6338
Practice Address - Fax:715-234-8364
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4509-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1598136012Medicaid
WIK100255366Medicare PIN