Provider Demographics
NPI:1447917703
Name:GRIESBACH, ISAIAH J (DC)
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:J
Last Name:GRIESBACH
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 1:105 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:BONDUEL
Mailing Address - State:WI
Mailing Address - Zip Code:54107-9243
Mailing Address - Country:US
Mailing Address - Phone:715-851-4461
Mailing Address - Fax:
Practice Address - Street 1:1624 E MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-2739
Practice Address - Country:US
Practice Address - Phone:920-465-0400
Practice Address - Fax:920-465-1430
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5693-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty