Healthcare Provider Details

I. General information

NPI: 1255490108
Provider Name (Legal Business Name): CHRISTOPHER JAMES KROLL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125A E PINE ST
LAKE MILLS WI
53551-1103
US

IV. Provider business mailing address

125A E PINE ST
LAKE MILLS WI
53551-1103
US

V. Phone/Fax

Practice location:
  • Phone: 920-648-6466
  • Fax:
Mailing address:
  • Phone: 920-648-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3422
License Number StateWI

VIII. Authorized Official

Name: DR. CHRISTOPHER J KROLL
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 920-648-6466