Provider Demographics
NPI:1104922277
Name:KOLANDER, JENNIFER JILL (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JILL
Last Name:KOLANDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:RETTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:826 2ND AVE. N.
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2208
Mailing Address - Country:US
Mailing Address - Phone:608-781-9555
Mailing Address - Fax:
Practice Address - Street 1:826 2ND AVE. N.
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2208
Practice Address - Country:US
Practice Address - Phone:608-781-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3537-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIDA4666OtherRAILROAD MEDICARE GROUP
WI38907600Medicaid
WIWI2648001OtherMEDICARE PTAN INDIVIDUAL
WI350053001OtherRAILROAD MEDICARE
WIWI2648OtherMEDICARE GROUP PTAN
WI38907600Medicaid