Provider Demographics
NPI:1346318516
Name:EGELSEER, BRETT CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:CHARLES
Last Name:EGELSEER
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 1:260 FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-1216
Mailing Address - Country:US
Mailing Address - Phone:920-467-6281
Mailing Address - Fax:920-467-6919
Practice Address - Street 1:260 FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-1216
Practice Address - Country:US
Practice Address - Phone:920-467-6281
Practice Address - Fax:920-467-6919
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3445-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38957400Medicaid
WI38957400Medicaid
WI35596Medicare ID - Type Unspecified