Provider Demographics
NPI:1619087533
Name:DONNERMEYER, BRADLEY P (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:P
Last Name:DONNERMEYER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 N CASALOMA DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8606
Mailing Address - Country:US
Mailing Address - Phone:920-734-2400
Mailing Address - Fax:920-734-2100
Practice Address - Street 1:873 N CASALOMA DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8606
Practice Address - Country:US
Practice Address - Phone:920-734-2400
Practice Address - Fax:920-734-2100
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3844 012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38939500Medicaid
U93493Medicare UPIN
WI38939500Medicaid