Provider Demographics
NPI:1356991327
Name:DAMROW, KRYSTALLYNNE MARIE
Entity type:Individual
Prefix:
First Name:KRYSTALLYNNE
Middle Name:MARIE
Last Name:DAMROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8646 US HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-9501
Mailing Address - Country:US
Mailing Address - Phone:715-532-6394
Mailing Address - Fax:
Practice Address - Street 1:3301 GOLF RD STE 102
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-9085
Practice Address - Country:US
Practice Address - Phone:715-514-4302
Practice Address - Fax:715-514-4432
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5453-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor