Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1667-012 | WI |
NPI | 1295816700 |
---|---|
Provider Name | Brian Carl Hurtgen |
First Address | Altoona, WI 54720-1028 |
Second Address | Chippewa Falls, WI 54729-3639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38768500 | (05) | WI |
T62276 | (02) | WI |