Provider Demographics
NPI:1821148503
Name:ARNOLD, VIRGINIA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MARIE
Last Name:ARNOLD
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 1:5516 STATE ROAD 11
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4278
Mailing Address - Country:US
Mailing Address - Phone:262-723-1532
Mailing Address - Fax:262-723-1532
Practice Address - Street 1:5516 STATE ROAD 11
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4278
Practice Address - Country:US
Practice Address - Phone:262-723-1532
Practice Address - Fax:262-723-1532
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3739-012111N00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035528Medicaid
WI000035528Medicare ID - Type Unspecified