Provider Demographics
NPI:1598820664
Name:BRENNAN GOESSL, CASEY CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:CHRISTOPHER
Last Name:BRENNAN GOESSL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CASEY
Other - Middle Name:CHRISTOPHER
Other - Last Name:GOESSL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:407 LASER DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:WI
Mailing Address - Zip Code:54025-7430
Mailing Address - Country:US
Mailing Address - Phone:715-247-4009
Mailing Address - Fax:715-247-3366
Practice Address - Street 1:407 LASER DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:WI
Practice Address - Zip Code:54025-7430
Practice Address - Country:US
Practice Address - Phone:715-247-4009
Practice Address - Fax:715-247-3366
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4271-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38972500Medicaid
WI38972500Medicaid
WIV10866Medicare UPIN