Provider Demographics
NPI:1033775143
Name:GENRICH, KIRSTIN ELIZABETH ROSS (DC)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:ELIZABETH ROSS
Last Name:GENRICH
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 1:1500 MERRILL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2590
Mailing Address - Country:US
Mailing Address - Phone:715-679-8585
Mailing Address - Fax:
Practice Address - Street 1:1500 MERRILL AVE STE 201
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2590
Practice Address - Country:US
Practice Address - Phone:715-679-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor