Provider Demographics
NPI:1972503316
Name:KUMBALEK CHIROPRACTIC CENTER SC
Entity Type:Organization
Organization Name:KUMBALEK CHIROPRACTIC CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUMBALEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-683-3800
Mailing Address - Street 1:2510 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4858
Mailing Address - Country:US
Mailing Address - Phone:920-683-3800
Mailing Address - Fax:920-683-1230
Practice Address - Street 1:2510 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4858
Practice Address - Country:US
Practice Address - Phone:920-683-3800
Practice Address - Fax:920-683-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38837000Medicaid
WI38837000Medicaid