Provider Demographics
NPI:1689480139
Name:TANGWALL, KODYE JOAN (DC)
Entity type:Individual
Prefix:
First Name:KODYE
Middle Name:JOAN
Last Name:TANGWALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KODYE
Other - Middle Name:JOAN
Other - Last Name:HOVDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:487 E TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-1102
Mailing Address - Country:US
Mailing Address - Phone:715-403-3718
Mailing Address - Fax:
Practice Address - Street 1:16 W JOHN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2910
Practice Address - Country:US
Practice Address - Phone:715-234-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6257-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor