Provider Demographics
NPI:1881709269
Name:RAIHALA, CARMEL JOY (DC CCSP)
Entity type:Individual
Prefix:DR
First Name:CARMEL
Middle Name:JOY
Last Name:RAIHALA
Suffix:
Gender:F
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 S ASLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304
Mailing Address - Country:US
Mailing Address - Phone:920-432-7774
Mailing Address - Fax:920-432-7784
Practice Address - Street 1:1804 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304
Practice Address - Country:US
Practice Address - Phone:920-432-7774
Practice Address - Fax:920-432-7784
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00209325OtherRAILROAD MEDIARE PIN #
WI38871800Medicaid
WI38871800Medicaid
WI000135550Medicare ID - Type Unspecified