Provider Demographics
NPI:1447463161
Name:VANCE, JULIE ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ELIZABETH
Last Name:VANCE
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 1:3101 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3018
Mailing Address - Country:US
Mailing Address - Phone:414-481-8683
Mailing Address - Fax:
Practice Address - Street 1:3101 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-3018
Practice Address - Country:US
Practice Address - Phone:414-481-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2424-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT79170Medicare UPIN