Provider Demographics
NPI:1003987652
Name:BREIDENBACH FAMILY AND SPORTS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BREIDENBACH FAMILY AND SPORTS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BREIDENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-386-9538
Mailing Address - Street 1:1526 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-4500
Mailing Address - Country:US
Mailing Address - Phone:608-781-9880
Mailing Address - Fax:
Practice Address - Street 1:1526 ROSE ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-4500
Practice Address - Country:US
Practice Address - Phone:608-781-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38930000Medicaid
U83038Medicare UPIN
WI000035980Medicare ID - Type Unspecified