Provider Demographics
NPI:1760505580
Name:BRESSLER, DARREN WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:WADE
Last Name:BRESSLER
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 1:807 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4419
Mailing Address - Country:US
Mailing Address - Phone:307-742-6840
Mailing Address - Fax:307-745-3712
Practice Address - Street 1:807 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4419
Practice Address - Country:US
Practice Address - Phone:307-742-6840
Practice Address - Fax:307-745-3712
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW9250Medicare PIN