Provider Demographics
NPI:1841308079
Name:PIMBLETT, MARY JOANNE (DC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOANNE
Last Name:PIMBLETT
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 1:3128 STARR AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-0972
Mailing Address - Country:US
Mailing Address - Phone:715-828-1655
Mailing Address - Fax:
Practice Address - Street 1:3321 GOLF RD STE A
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-9190
Practice Address - Country:US
Practice Address - Phone:715-832-1953
Practice Address - Fax:715-832-0225
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4243-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001175035Medicare NSC
WI09985Medicare UPIN