Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4929-12 | WI |
NPI | 1003257452 |
---|---|
Provider Name | Mr. Garrett J Brugger |
First Address | West Bend, WI 53095-8533 |
Second Address | West Bend, WI 53095-8533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 15/07/2013 |