Provider Demographics
NPI:1609940832
Name:BREUNIG FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BREUNIG FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREUNIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-643-4686
Mailing Address - Street 1:8959 WATERFORD RD
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-9569
Mailing Address - Country:US
Mailing Address - Phone:608-643-4686
Mailing Address - Fax:
Practice Address - Street 1:113 S MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LODI
Practice Address - State:WI
Practice Address - Zip Code:53555-1163
Practice Address - Country:US
Practice Address - Phone:608-643-4686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4259-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty