Provider Demographics
NPI:1255582375
Name:NIEBRZYDOWSKI, KERRY COLENSO (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:COLENSO
Last Name:NIEBRZYDOWSKI
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-1207
Mailing Address - Country:US
Mailing Address - Phone:715-251-3555
Mailing Address - Fax:715-251-3559
Practice Address - Street 1:1111 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-1207
Practice Address - Country:US
Practice Address - Phone:715-251-3555
Practice Address - Fax:715-251-3559
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI652-055171100000X
OR1632175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist