Otto, Kenneth Lee
Otto, Kenneth Lee is an sole proprietor health care provider with primary practice located at 308 E Northland Ave , Appleton WI 54911-2163. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Otto, Kenneth Lee can be contacted via phone (920) 739-6800.Contact Information
Primary practice address
308 E Northland Ave
Appleton WI 54911-2163
Phone: (920) 739-6800
Fax: (920) 739-3999
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 3082-012 | Wisconsin |
Profile Details
| NPI number | 1770647521 |
|---|---|
| LBN Legal business name | Otto, Kenneth Lee |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 19th, 2006 |
| Last updated | Aug 30th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770647521 | NPPES |
| Wisconsin | MEDICAID | 38976800 |
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