Provider Demographics
NPI:1033444195
Name:BREITBACH, NORRIS DUANE (DC)
Entity Type:Individual
Prefix:DR
First Name:NORRIS
Middle Name:DUANE
Last Name:BREITBACH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 N MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1430
Mailing Address - Country:US
Mailing Address - Phone:608-835-5353
Mailing Address - Fax:608-835-8990
Practice Address - Street 1:167 N MAIN ST.
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-1430
Practice Address - Country:US
Practice Address - Phone:608-835-5353
Practice Address - Fax:608-835-8990
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38807300Medicaid
WI391407437Medicare PIN