Provider Demographics
NPI:1750549556
Name:SIPPLE, KRISTINA THERESE (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:THERESE
Last Name:SIPPLE
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 1:931 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2211
Mailing Address - Country:US
Mailing Address - Phone:715-304-9233
Mailing Address - Fax:
Practice Address - Street 1:931 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2211
Practice Address - Country:US
Practice Address - Phone:715-304-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4381-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38186700Medicaid
WI38186700Medicaid