Provider Demographics
NPI:1205495835
Name:KNOELKE, ANDREA K (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:K
Last Name:KNOELKE
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:W1081 LEWIS LN APT 13
Mailing Address - Street 2:
Mailing Address - City:IXONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53036-9428
Mailing Address - Country:US
Mailing Address - Phone:920-253-1663
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:920-648-4365
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5444-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor