Provider Demographics
NPI:1477879468
Name:GATEWAY CHIROPRACTIC AND REHABILITATION LLC
Entity Type:Organization
Organization Name:GATEWAY CHIROPRACTIC AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEXLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-691-7562
Mailing Address - Street 1:1166 QUAIL CT
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3769
Mailing Address - Country:US
Mailing Address - Phone:262-691-7562
Mailing Address - Fax:262-691-7572
Practice Address - Street 1:1166 QUAIL CT
Practice Address - Street 2:SUITE 315
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3769
Practice Address - Country:US
Practice Address - Phone:262-691-7562
Practice Address - Fax:262-691-7572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4403-012261QH0100X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty