Healthcare Provider Details

I. General information

NPI: 1568424232
Provider Name (Legal Business Name): PEGGY SUE LINNEMAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S. 2ND ST. SUITE 101
WHITEWATER WI
53190-2083
US

IV. Provider business mailing address

214 S. 2ND ST. SUITE 101
WHITEWATER WI
53190-2083
US

V. Phone/Fax

Practice location:
  • Phone: 262-472-0209
  • Fax: 262-472-0211
Mailing address:
  • Phone: 262-472-0209
  • Fax: 262-472-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3407-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: