Provider Demographics
NPI:1124995006
Name:BRAIN BALANCE CENTER OF MEQUON
Entity type:Organization
Organization Name:BRAIN BALANCE CENTER OF MEQUON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTNACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-309-2774
Mailing Address - Street 1:12075 N CORPORATE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-2664
Mailing Address - Country:US
Mailing Address - Phone:262-240-9915
Mailing Address - Fax:
Practice Address - Street 1:12075 N CORPORATE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-2664
Practice Address - Country:US
Practice Address - Phone:262-240-9915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-23
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty