Provider Demographics
NPI:1013973155
Name:KRIESER, KENNETH J (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:KRIESER
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:W329N4362 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:NASHOTAH
Mailing Address - State:WI
Mailing Address - Zip Code:53058-9708
Mailing Address - Country:US
Mailing Address - Phone:262-563-1000
Mailing Address - Fax:262-563-1200
Practice Address - Street 1:W329N4362 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:NASHOTAH
Practice Address - State:WI
Practice Address - Zip Code:53058-9708
Practice Address - Country:US
Practice Address - Phone:262-563-1000
Practice Address - Fax:262-563-1200
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4167-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38967400Medicaid
WI000035831Medicare PIN