Provider Demographics
NPI:1124111752
Name:MITTELSTEDT, CHERYL LYNN (DC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:MITTELSTEDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ROCKWELL AVE EAST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2629
Mailing Address - Country:US
Mailing Address - Phone:920-563-7300
Mailing Address - Fax:920-691-0037
Practice Address - Street 1:38 ROCKWELL AVE EAST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-2629
Practice Address - Country:US
Practice Address - Phone:920-563-7300
Practice Address - Fax:920-691-0037
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor