1336684570 NPI number — MISS KAYLA MARIE FRANZLUEBBERS D.C.

Table of content: MISS KAYLA MARIE FRANZLUEBBERS D.C. (NPI 1336684570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336684570 NPI number — MISS KAYLA MARIE FRANZLUEBBERS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANZLUEBBERS
Provider First Name:
KAYLA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336684570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1939 ROAD 18
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DODGE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68633-3102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-380-5058
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2920 S WEBSTER AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54301-1594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-347-4884
Provider Business Practice Location Address Fax Number:
920-347-4878
Provider Enumeration Date:
12/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5229-12 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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