Provider Demographics
NPI:1811462971
Name:KIENOL, ZACHARY IVAN (DC)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:IVAN
Last Name:KIENOL
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 1:150 S SUNNY SLOPE RD STE 148
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6461
Mailing Address - Country:US
Mailing Address - Phone:262-395-4023
Mailing Address - Fax:262-649-3953
Practice Address - Street 1:150 S SUNNY SLOPE RD STE 148
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6461
Practice Address - Country:US
Practice Address - Phone:262-395-4023
Practice Address - Fax:262-649-3953
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5302-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor