Provider Demographics
NPI:1790852176
Name:VERKUILEN, CARRIE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:MARIE
Last Name:VERKUILEN
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 1:1401 E ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3121
Mailing Address - Country:US
Mailing Address - Phone:715-524-6720
Mailing Address - Fax:715-524-5581
Practice Address - Street 1:1401 E ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-3121
Practice Address - Country:US
Practice Address - Phone:715-524-6720
Practice Address - Fax:715-524-5581
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI3637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38926200Medicaid
WI38926200Medicaid
WIU78634Medicare UPIN