Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5616-12 | WI |
N | 111NX0100X | Occupational Health | 5616-12 | WI |
NPI | 1033795604 |
---|---|
Provider Name | Brady Spielbauer |
First Address | De Pere, WI 54115-9567 |
Second Address | De Pere, WI 54115-9567 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2021 |
Last Update Date | 23/03/2021 |