Provider Demographics
NPI:1912360983
Name:SCHIELKE, ALEC LARS (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEC
Middle Name:LARS
Last Name:SCHIELKE
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 1:612 FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-1224
Mailing Address - Country:US
Mailing Address - Phone:920-946-4548
Mailing Address - Fax:
Practice Address - Street 1:612 FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-1224
Practice Address - Country:US
Practice Address - Phone:920-946-4548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor