Carolyn Beth Custer, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

636-55 Issued in WI

Practice address

112 S Main St Ste 2a
Jefferson, WI 53549-1657

Phone

(920) 674-6707

Fax

(920) 674-6707

NPI assigned

Mar 18, 2011

Last updated

Mar 13, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1679872576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 S MAIN ST STE 2A",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535491657",
            "telephone_number": "920-674-6707",
            "fax_number": "920-674-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 S MAIN ST STE 2A",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535491657",
            "telephone_number": "920-674-6707",
            "fax_number": "920-674-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSTER",
        "first_name": "CAROLYN",
        "middle_name": "BETH",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-18",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "WI",
            "license": "636-55",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS",
            "identifier": "1679872576",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chiropractic Care Centers, S.C. (Chiropractic Care Center - Jefferson)
• City of Jefferson (Jefferson EMS)
• Community Counseling & Evaluation Services, LLC
• Country Nurses, Inc.
• Rebecca Lynn Cox
• David J Volk DC SC
• Becca Davies
• Karalyn Dehn
• Heather Lynn Dempsey, LCSW
• Krista L Doerr, LPC

• Acupuncturist in Jefferson, WI
• Providers in Jefferson, WI by specialty
• Acupuncturist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.