Individual
MR. GLEN E ROOYAKKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC DACNB
Contact information
Practice address
702 EISENHOWER DRIVE, SUITE G, KIMBERLY, WI 54136
(920) 730-1155
(920) 730-1148
Mailing address
702 EISENHOWER DRIVE, SUITE G, KIMBERLY, WI 54136
(920) 730-1155
(920) 730-1148
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2603 012
WI
111NN0400X
Neurology Chiropractor
2603 012
WI
111NS0005X
Sports Physician Chiropractor
2603 012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38848900
—
WI
Enumeration date
08/30/2006
Last updated
07/14/2010
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