Provider Demographics
NPI:1811013329
Name:LIMBACH, CHRISTOPHER PETER (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PETER
Last Name:LIMBACH
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 67TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-3808
Mailing Address - Country:US
Mailing Address - Phone:262-605-4770
Mailing Address - Fax:262-605-4774
Practice Address - Street 1:3916 67TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142
Practice Address - Country:US
Practice Address - Phone:262-605-4770
Practice Address - Fax:262-605-4774
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3720012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1811013329Medicaid