Individual
MR. BEETHOVEN CARABACAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LAT, CSCS, BS, MS
Contact information
Practice address
1111 DELAFIELD ST, SUITE 15, WAUKESHA, WI 53188-3417
(262) 521-9762
(262) 521-1091
Mailing address
1300 N 116TH ST, APT. 3, WAUWATOSA, WI 53226-3262
(414) 324-4172
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
657-039
WI
Other
Enumeration date
04/20/2006
Last updated
07/08/2007
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