Provider Demographics
NPI:1891823761
Name:CIBULA, PAUL J (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:CIBULA
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 1:1203 S MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-2120
Mailing Address - Country:US
Mailing Address - Phone:920-499-4575
Mailing Address - Fax:920-499-9607
Practice Address - Street 1:1203 S MILITARY AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-2120
Practice Address - Country:US
Practice Address - Phone:920-499-4575
Practice Address - Fax:920-499-9607
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38848300Medicaid
WIT95538Medicare UPIN