Provider Demographics
NPI:1881643120
Name:METROPULOS, MARY JANE-SHNOWSKE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE-SHNOWSKE
Last Name:METROPULOS
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:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-0113
Mailing Address - Country:US
Mailing Address - Phone:715-693-8111
Mailing Address - Fax:715-692-2529
Practice Address - Street 1:309 4TH ST
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-1109
Practice Address - Country:US
Practice Address - Phone:715-693-8111
Practice Address - Fax:715-692-2529
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000135853Medicare PIN
WI000135852Medicare PIN