1639615941 NPI number — DR. STEPHANIE KAYE TYJESKI D.C.

Table of content: DR. STEPHANIE KAYE TYJESKI D.C. (NPI 1639615941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639615941 NPI number — DR. STEPHANIE KAYE TYJESKI D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYJESKI
Provider First Name:
STEPHANIE
Provider Middle Name:
KAYE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639615941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 E MACKIE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER DAM
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53916-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-885-3020
Provider Business Mailing Address Fax Number:
920-885-3024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 S 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53094-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-261-0855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5238-12 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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