Provider Demographics
NPI:1184715146
Name:FOGELTANZ, KAY ANN (DC)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:ANN
Last Name:FOGELTANZ
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 1:2170 VELP AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-6596
Mailing Address - Country:US
Mailing Address - Phone:920-471-8973
Mailing Address - Fax:920-465-6760
Practice Address - Street 1:2170 VELP AVE STE 105
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-6596
Practice Address - Country:US
Practice Address - Phone:920-471-8973
Practice Address - Fax:920-465-6760
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38909800Medicaid
WI38909800Medicaid
WIU74965Medicare UPIN