Provider Demographics
NPI:1215057450
Name:KOMASA, CHRIS P (DC)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:P
Last Name:KOMASA
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 1:3108 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-5305
Mailing Address - Country:US
Mailing Address - Phone:715-341-0910
Mailing Address - Fax:715-341-0093
Practice Address - Street 1:3108 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-5305
Practice Address - Country:US
Practice Address - Phone:715-341-0910
Practice Address - Fax:715-341-0093
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38898700Medicaid
WIDG2212OtherRAILROAD MEDICARE-GRP#
WI350037232OtherRAILROAD MEDICARE-INDIV #
WI350037232OtherRAILROAD MEDICARE-INDIV #
WI000575785Medicare PIN
WI757850005Medicare ID - Type Unspecified