Provider Demographics
NPI:1689139958
Name:TRUE NORTH HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:TRUE NORTH HEALTH AND WELLNESS LLC
Other - Org Name:TRUE NORTH HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NUTTING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-915-2727
Mailing Address - Street 1:W234S3555 STATE ROAD 59
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-8512
Mailing Address - Country:US
Mailing Address - Phone:414-915-2727
Mailing Address - Fax:
Practice Address - Street 1:W234S3555 STATE ROAD 59
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-8512
Practice Address - Country:US
Practice Address - Phone:414-915-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1558536185Medicaid