Provider Demographics
NPI:1720185796
Name:BRUGGER CHIROPRACTIC S.C.
Entity Type:Organization
Organization Name:BRUGGER CHIROPRACTIC S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRUGGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-334-4847
Mailing Address - Street 1:1624 CLARENCE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-8533
Mailing Address - Country:US
Mailing Address - Phone:262-334-4847
Mailing Address - Fax:262-334-5554
Practice Address - Street 1:1624 CLARENCE CT
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-8533
Practice Address - Country:US
Practice Address - Phone:262-334-4847
Practice Address - Fax:262-334-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2674-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38904700Medicaid
WI75271Medicare ID - Type Unspecified
WIU20774Medicare UPIN