Provider Demographics
NPI:1447343587
Name:MARSDEN-DULL, PATRICIA EILEEN (DC, CCSP)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:EILEEN
Last Name:MARSDEN-DULL
Suffix:
Gender:F
Credentials:DC, CCSP
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 130
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-0130
Mailing Address - Country:US
Mailing Address - Phone:262-877-2196
Mailing Address - Fax:262-877-2204
Practice Address - Street 1:6905 GREEN BAY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-1458
Practice Address - Country:US
Practice Address - Phone:262-697-5000
Practice Address - Fax:262-697-1996
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3753-012111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38995500Medicaid
WI000035620Medicare ID - Type Unspecified