Provider Demographics
NPI:1821102542
Name:SENORASKE, BRIAN JAMES (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:SENORASKE
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 1:314 N 2ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2372
Mailing Address - Country:US
Mailing Address - Phone:715-425-6100
Mailing Address - Fax:715-425-9573
Practice Address - Street 1:314 N 2ND ST
Practice Address - Street 2:STE 200
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2372
Practice Address - Country:US
Practice Address - Phone:715-425-6100
Practice Address - Fax:715-425-9573
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3731-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor