Provider Demographics
NPI:1164946026
Name:LAROCQUE, BRITTANY ROSE (DC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ROSE
Last Name:LAROCQUE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-2257
Mailing Address - Country:US
Mailing Address - Phone:715-341-2644
Mailing Address - Fax:
Practice Address - Street 1:1115 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2257
Practice Address - Country:US
Practice Address - Phone:715-341-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5298-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor