Provider Demographics
NPI:1851977789
Name:SIEMSEN, KURTIS JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:JAMES
Last Name:SIEMSEN
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 1:1 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BUFFALO
Mailing Address - State:MI
Mailing Address - Zip Code:49117
Mailing Address - Country:US
Mailing Address - Phone:269-469-1310
Mailing Address - Fax:
Practice Address - Street 1:820 GENEVA PKWY N STE 105
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4562
Practice Address - Country:US
Practice Address - Phone:262-248-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401215111N00000X
WI5621-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1154510519Medicaid
WI1154510519OtherEXCEL FAMILY CHIROPRACTIC