Provider Demographics
NPI:1740341437
Name:ISOM, EILEEN MARIE (DC)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:ISOM
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 1:6000 GISHOLT DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4816
Mailing Address - Country:US
Mailing Address - Phone:608-221-1597
Mailing Address - Fax:608-221-1455
Practice Address - Street 1:6000 GISHOLT DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4816
Practice Address - Country:US
Practice Address - Phone:608-221-1597
Practice Address - Fax:608-221-1455
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38827200Medicaid
WIT62286Medicare UPIN