Provider Demographics
NPI:1013072750
Name:POMPLUN, COLLEEN (DC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:POMPLUN
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 458
Mailing Address - Street 2:
Mailing Address - City:GREEN LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54941-0458
Mailing Address - Country:US
Mailing Address - Phone:920-294-3130
Mailing Address - Fax:920-294-3238
Practice Address - Street 1:505 LAKE STREET
Practice Address - Street 2:
Practice Address - City:GREEN LAKE
Practice Address - State:WI
Practice Address - Zip Code:54941
Practice Address - Country:US
Practice Address - Phone:920-294-3130
Practice Address - Fax:920-294-3238
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38873800Medicaid
WI38873800Medicaid
WIU43708Medicare UPIN