Provider Demographics
NPI:1255490108
Name:CHRISTOPHER JAMES KROLL
Entity type:Organization
Organization Name:CHRISTOPHER JAMES KROLL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-648-6466
Mailing Address - Street 1:125A E PINE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1103
Mailing Address - Country:US
Mailing Address - Phone:920-648-6466
Mailing Address - Fax:
Practice Address - Street 1:125A E PINE ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1103
Practice Address - Country:US
Practice Address - Phone:920-648-6466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========018OtherBC/BS
WIU71036Medicare UPIN
WI000230146Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID