Provider Demographics
NPI:1265763023
Name:KOLMAN FAM CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KOLMAN FAM CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-968-2232
Mailing Address - Street 1:300 E SUMMIT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183-9664
Mailing Address - Country:US
Mailing Address - Phone:262-968-2232
Mailing Address - Fax:262-968-5132
Practice Address - Street 1:300 E SUMMIT AVE STE D
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9664
Practice Address - Country:US
Practice Address - Phone:262-968-2232
Practice Address - Fax:262-968-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3903-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38942600Medicaid
WI38942600Medicaid