Provider Demographics
NPI:1528050325
Name:KINDSCHI, JASON C (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:KINDSCHI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-9211
Mailing Address - Country:US
Mailing Address - Phone:608-839-1172
Mailing Address - Fax:608-839-1174
Practice Address - Street 1:204 W COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-9211
Practice Address - Country:US
Practice Address - Phone:608-839-1172
Practice Address - Fax:608-839-1174
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38959000Medicaid
WI38959000Medicaid
WI001835155Medicare ID - Type Unspecified