Provider Demographics
NPI:1295816700
Name:HURTGEN, BRIAN CARL (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CARL
Last Name:HURTGEN
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 1:3324 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-1028
Mailing Address - Country:US
Mailing Address - Phone:715-836-7648
Mailing Address - Fax:715-720-6089
Practice Address - Street 1:235 W PRAIRIE VIEW RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3639
Practice Address - Country:US
Practice Address - Phone:715-720-9097
Practice Address - Fax:715-720-6089
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1667-012111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38768500Medicaid
WI38768500Medicaid