Provider Demographics
NPI:1366031569
Name:SAMOLESKI, BREANNA (DC)
Entity Type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:
Last Name:SAMOLESKI
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 1:832 CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7759
Mailing Address - Country:US
Mailing Address - Phone:715-381-1800
Mailing Address - Fax:715-381-5234
Practice Address - Street 1:832 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7759
Practice Address - Country:US
Practice Address - Phone:715-381-1800
Practice Address - Fax:715-381-5234
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5609-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor