Provider Demographics
NPI:1447348594
Name:STORLEY, CHRISTINE MARIE (DC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:STORLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 WEST MAIN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1930
Mailing Address - Country:US
Mailing Address - Phone:608-837-2828
Mailing Address - Fax:608-837-0105
Practice Address - Street 1:1268 WEST MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1930
Practice Address - Country:US
Practice Address - Phone:608-837-2828
Practice Address - Fax:608-837-0105
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3778012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38934300Medicaid
WI38934300Medicaid