Provider Demographics
NPI:1790895217
Name:DONNERMEYER CHIROPRACTIC L.L. C.
Entity Type:Organization
Organization Name:DONNERMEYER CHIROPRACTIC L.L. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DONNERMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-734-2400
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2798111N00000X
WI3834012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI500923885001OtherDR JAMES MARKOVICH BCBS
WI38907500Medicaid
WI394829414OtherDR AMY NUSSBAUM'S NETWORK
WI394829414EO4OtherDR AMY NUSSBAUM'S BCBS
WI500923885OtherDR MARKOVICH'S NETWORK
WI664130OtherDR NUSSBAUM UNITEDHEALTH
WI664066OtherDR MARKOVICH UNITEDHEALTH
WI38935800Medicaid
WI664066OtherDR MARKOVICH UNITEDHEALTH
WIU93650Medicare UPIN
WI35700Medicare ID - Type Unspecified