Provider Demographics
NPI:1205087913
Name:KOLBECK, JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:KOLBECK
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:W202 N10418 APPLETON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3700
Mailing Address - Country:US
Mailing Address - Phone:414-587-6985
Mailing Address - Fax:
Practice Address - Street 1:W 202 N 10418 APPLETON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3700
Practice Address - Country:US
Practice Address - Phone:414-587-6985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIW13579-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI80262Medicare UPIN