Provider Demographics
NPI:1649262403
Name:YELLEN-SHIRING, EUGENE R (DC)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:R
Last Name:YELLEN-SHIRING
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 1:3070 FISH HATCHERY RD
Mailing Address - Street 2:STE 2
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3187
Mailing Address - Country:US
Mailing Address - Phone:608-231-3370
Mailing Address - Fax:608-231-1547
Practice Address - Street 1:2702 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1888
Practice Address - Country:US
Practice Address - Phone:608-231-3370
Practice Address - Fax:608-231-1547
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38865400Medicaid
WI000235155Medicare ID - Type Unspecified
WIU32080Medicare UPIN