Provider Demographics
NPI:1780613968
Name:LOGELIN, JOEL STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:STEPHEN
Last Name:LOGELIN
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 1:1605 7 1/2 AVENUE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:WI
Mailing Address - Zip Code:54733-9457
Mailing Address - Country:US
Mailing Address - Phone:715-837-1622
Mailing Address - Fax:715-837-1622
Practice Address - Street 1:1605 7 1/2 AVENUE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:WI
Practice Address - Zip Code:54733-9457
Practice Address - Country:US
Practice Address - Phone:715-837-1622
Practice Address - Fax:715-837-1622
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1672-012111N00000X
WY653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38985300Medicaid
WI38985300Medicaid
WIT62622Medicare UPIN