Provider Demographics
NPI:1578507331
Name:LEO J BRONSTON
Entity Type:Organization
Organization Name:LEO J BRONSTON
Other - Org Name:BRONSTON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRONSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-781-2225
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-0783
Mailing Address - Country:US
Mailing Address - Phone:608-781-2225
Mailing Address - Fax:608-782-3486
Practice Address - Street 1:1202 COUNTY ROAD PH
Practice Address - Street 2:SUITE 100
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8439
Practice Address - Country:US
Practice Address - Phone:608-781-2225
Practice Address - Fax:608-781-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38983400Medicaid