Provider Demographics
NPI:1770693681
Name:ROOYAKKERS, WANDA J (DC)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:J
Last Name:ROOYAKKERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:J
Other - Last Name:ROEBKE-ROOYAKKERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC DACNB
Mailing Address - Street 1:702 EISENHOWER DRIVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136
Mailing Address - Country:US
Mailing Address - Phone:920-730-1155
Mailing Address - Fax:920-730-1148
Practice Address - Street 1:702 EISENHOWER DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136
Practice Address - Country:US
Practice Address - Phone:920-730-1155
Practice Address - Fax:920-730-1148
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2601 012111N00000X, 111NN0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38848800Medicaid
U01811Medicare UPIN