Provider Demographics
NPI:1790863009
Name:KUMBALEK, KEVIN J (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:KUMBALEK
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 1:2510 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4858
Mailing Address - Country:US
Mailing Address - Phone:920-683-3800
Mailing Address - Fax:920-683-1230
Practice Address - Street 1:2510 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4858
Practice Address - Country:US
Practice Address - Phone:920-683-3800
Practice Address - Fax:920-683-1230
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2338-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38837000Medicaid
WIT 62512Medicare UPIN
WI38837000Medicaid