Provider Demographics
NPI:1295947406
Name:SCHWALENBERG, LEE CHARLES
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:CHARLES
Last Name:SCHWALENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 CROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-3914
Mailing Address - Country:US
Mailing Address - Phone:920-462-0912
Mailing Address - Fax:920-462-0914
Practice Address - Street 1:2450 CROOKS AVE
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-3914
Practice Address - Country:US
Practice Address - Phone:920-462-0912
Practice Address - Fax:920-462-0914
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4159-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38963400Medicaid
WI000235807Medicare ID - Type UnspecifiedMEDICARE