Healthcare Provider Details

I. General information

NPI: 1427012186
Provider Name (Legal Business Name): STEVEN ALAN BIRKETT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 LINCOLN AVE
FENNIMORE WI
53809-1742
US

IV. Provider business mailing address

990 LINCOLN AVE PO BOX 68
FENNIMORE WI
53809-1742
US

V. Phone/Fax

Practice location:
  • Phone: 608-822-3260
  • Fax: 608-822-3261
Mailing address:
  • Phone: 608-822-3260
  • Fax: 608-822-3261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3022-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: