Provider Demographics
NPI:1811208275
Name:PEDERSEN, MARGARET (DAOMC, MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:DAOMC, MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W125S6955 SKYLARK LN
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-3526
Mailing Address - Country:US
Mailing Address - Phone:414-377-8005
Mailing Address - Fax:414-377-8005
Practice Address - Street 1:3970 N OAKLAND AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2265
Practice Address - Country:US
Practice Address - Phone:414-331-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI643-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist