Provider Demographics
NPI:1487710075
Name:ADERHOLDT, JOHN T (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:ADERHOLDT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:T
Other - Last Name:ADERHOLDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:W9682 E CRYSTAL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PICKEREL
Mailing Address - State:WI
Mailing Address - Zip Code:54465-9648
Mailing Address - Country:US
Mailing Address - Phone:715-216-6528
Mailing Address - Fax:
Practice Address - Street 1:W9682 E CRYSTAL LAKE RD
Practice Address - Street 2:
Practice Address - City:PICKEREL
Practice Address - State:WI
Practice Address - Zip Code:54465-9648
Practice Address - Country:US
Practice Address - Phone:715-216-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2622-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor