Provider Demographics
NPI:1962041061
Name:GREIMANN, KENDYL ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:KENDYL
Middle Name:ROSE
Last Name:GREIMANN
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 1:4250 UNIVERSITY AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2134
Mailing Address - Country:US
Mailing Address - Phone:719-332-4666
Mailing Address - Fax:
Practice Address - Street 1:2639 UNIVERSITY AVE # 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3750
Practice Address - Country:US
Practice Address - Phone:608-721-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5508-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor