Provider Demographics
NPI:1992233183
Name:WAHL, KRISTIN MARIE (DC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:WAHL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:LUCKSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:500 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CADOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54727-9401
Mailing Address - Country:US
Mailing Address - Phone:715-289-5000
Mailing Address - Fax:715-289-3388
Practice Address - Street 1:3120 SCHNEIDER AVE SE STE 5
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2592
Practice Address - Country:US
Practice Address - Phone:715-232-8858
Practice Address - Fax:715-232-8868
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5291-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor