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General NPI Number Information
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NPI Number | 1356991327
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Entity Type | Individual
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Provider Name | KRYSTALLYNNE MARIE DAMROW
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 3301 GOLF RD STE 102
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City | EAU CLAIRE
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State | WI
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Zip | 54701-9085
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Country | US
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Telephone | 715-514-4302
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Fax | 715-514-4432
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Provider Business Mailing Address
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Address Line | W8646 US HIGHWAY 8
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City | LADYSMITH
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State | WI
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Zip | 54848-9501
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Country | US
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Telephone | 715-532-6394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5453-12
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License Number State | WI
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