Provider Demographics
NPI:1194891630
Name:CROTTEAU, STEVEN DONALD (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DONALD
Last Name:CROTTEAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 W DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1530
Mailing Address - Country:US
Mailing Address - Phone:715-296-6977
Mailing Address - Fax:715-234-3809
Practice Address - Street 1:12 W MARSHALL ST
Practice Address - Street 2:SUITE #110
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2741
Practice Address - Country:US
Practice Address - Phone:715-234-3808
Practice Address - Fax:715-234-3809
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3891-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor