Provider Demographics
NPI:1205979937
Name:OAK CREEK RELIEF AND WELLNESS SC
Entity type:Organization
Organization Name:OAK CREEK RELIEF AND WELLNESS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:KRIMPELBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-761-5777
Mailing Address - Street 1:1900 W RYAN RD
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8233
Mailing Address - Country:US
Mailing Address - Phone:414-761-5777
Mailing Address - Fax:414-761-7915
Practice Address - Street 1:1900 W RYAN RD
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-8233
Practice Address - Country:US
Practice Address - Phone:414-761-5777
Practice Address - Fax:414-761-7915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01234Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER