Provider Demographics
NPI:1932447224
Name:PROTHERO, CHELSEA (DC)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:
Last Name:PROTHERO
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 1:2639 UNIVERSITY AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3750
Mailing Address - Country:US
Mailing Address - Phone:608-721-1445
Mailing Address - Fax:
Practice Address - Street 1:2639 UNIVERSITY AVE
Practice Address - Street 2:STE 200
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3750
Practice Address - Country:US
Practice Address - Phone:608-721-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100037386Medicaid
WIK400130652OtherMEDICARE PTAN