Provider Demographics
NPI:1992885289
Name:KLEMP, DARREL D (DC)
Entity type:Individual
Prefix:DR
First Name:DARREL
Middle Name:D
Last Name:KLEMP
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:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:BLACK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:54106-0261
Mailing Address - Country:US
Mailing Address - Phone:920-984-3353
Mailing Address - Fax:920-984-3354
Practice Address - Street 1:411 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACK CREEK
Practice Address - State:WI
Practice Address - Zip Code:54106-9501
Practice Address - Country:US
Practice Address - Phone:920-984-3353
Practice Address - Fax:920-984-3354
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2785-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38860500Medicaid
WI70327Medicare ID - Type Unspecified
WI38860500Medicaid