Healthcare Provider Details

I. General information

NPI: 1013072750
Provider Name (Legal Business Name): COLLEEN POMPLUN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 LAKE STREET
GREEN LAKE WI
54941
US

IV. Provider business mailing address

PO BOX 458
GREEN LAKE WI
54941-0458
US

V. Phone/Fax

Practice location:
  • Phone: 920-294-3130
  • Fax: 855-410-0730
Mailing address:
  • Phone: 920-294-3130
  • Fax: 855-410-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: