Provider Demographics
NPI:1508023417
Name:SPINEWORKS DECOMPRESSION & CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SPINEWORKS DECOMPRESSION & CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUESEWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-763-5800
Mailing Address - Street 1:925 MILWAUKEE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1351
Mailing Address - Country:US
Mailing Address - Phone:262-763-5800
Mailing Address - Fax:262-763-5815
Practice Address - Street 1:925 MILWAUKEE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1351
Practice Address - Country:US
Practice Address - Phone:262-763-5800
Practice Address - Fax:262-763-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3840-012305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU10079Medicare UPIN