Basic Information
| Provider Information | |||||||||
| NPI: | 1134211311 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BREITBACH DRAGOSH CHIROPRACTIC CLINIC, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 W WISCONSIN AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | KAUKAUNA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541302123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207663741 | ||||||||
| FaxNumber: | 9207595050 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 W WISCONSIN AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | KAUKAUNA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541302123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207663741 | ||||||||
| FaxNumber: | 9207595050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 08/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | NEWHOUSE | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9207663741 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.