Individual
CHARLES L SIVRET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
402 ELLIS ST, KEWAUNEE, WI 54216-1329
(920) 388-4499
(920) 388-4499
Mailing address
402 ELLIS ST, KEWAUNEE, WI 54216-1329
(920) 388-4499
(920) 388-4499
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1807-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000235937
MEDICARE PTAN
WI
05
—
38777700
—
WI
Enumeration date
07/29/2005
Last updated
02/11/2020
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