Individual
CARLI MARIE VANGOETHEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
402 ELLIS ST, KEWAUNEE, WI 54216-1329
(920) 388-4499
Mailing address
402 ELLIS ST, KEWAUNEE, WI 54216-1329
(920) 621-1854
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
114461
IA
111N00000X
Chiropractor
Primary
5778-12
WI
111NN1001X
Nutrition Chiropractor
5778-12
WI
111NR0200X
Radiology Chiropractor
5778-12
WI
Other
Enumeration date
05/17/2022
Last updated
03/15/2023
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