Provider Demographics
NPI:1437342607
Name:BREITBACH, DAVID R (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:BREITBACH
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:S3505 PRAIRIE EDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667-8234
Mailing Address - Country:US
Mailing Address - Phone:608-634-2181
Mailing Address - Fax:
Practice Address - Street 1:128 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1533
Practice Address - Country:US
Practice Address - Phone:608-634-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor