Healthcare Provider Details

I. General information

NPI: 1417652025
Provider Name (Legal Business Name): COLBY KASTEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILL ST
REEDSVILLE WI
54230-1700
US

IV. Provider business mailing address

106 MILL ST
REEDSVILLE WI
54230-1700
US

V. Phone/Fax

Practice location:
  • Phone: 920-901-3382
  • Fax:
Mailing address:
  • Phone: 920-588-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6069-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: