Healthcare Provider Details

I. General information

NPI: 1235171927
Provider Name (Legal Business Name): CASIMER KOBYLINSKI I D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 MICHIGAN AVE
SHEBOYGAN WI
53081-3350
US

IV. Provider business mailing address

934 MICHIGAN AVE
SHEBOYGAN WI
53081-3350
US

V. Phone/Fax

Practice location:
  • Phone: 920-458-2225
  • Fax:
Mailing address:
  • Phone: 920-458-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2190
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: