Provider Demographics
NPI:1225020233
Name:BRUGGER, JAMES P (DC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:BRUGGER
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 1:1624 CLARENCE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-8533
Mailing Address - Country:US
Mailing Address - Phone:262-334-4847
Mailing Address - Fax:262-334-5554
Practice Address - Street 1:1624 CLARENCE CT
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-8533
Practice Address - Country:US
Practice Address - Phone:262-334-4847
Practice Address - Fax:262-334-5554
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2674-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38904700Medicaid
WIU20774Medicare UPIN
WI38904700Medicaid