Provider Demographics
NPI:1730675026
Name:YEPSEN, BRYTON ALAN (DC)
Entity Type:Individual
Prefix:
First Name:BRYTON
Middle Name:ALAN
Last Name:YEPSEN
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 1:1024 60TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4099
Mailing Address - Country:US
Mailing Address - Phone:262-657-7744
Mailing Address - Fax:
Practice Address - Street 1:1024 60TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4099
Practice Address - Country:US
Practice Address - Phone:262-657-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5731-12111N00000X
WI5371-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor