Provider Demographics
NPI:1205921400
Name:WUSSOW, BRIAN ROBERT (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ROBERT
Last Name:WUSSOW
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 1:8434 OLD SAUK RD.
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-4367
Mailing Address - Country:US
Mailing Address - Phone:608-833-1114
Mailing Address - Fax:608-833-0551
Practice Address - Street 1:8434 OLD SAUK RD.
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-4367
Practice Address - Country:US
Practice Address - Phone:608-833-1114
Practice Address - Fax:608-833-0551
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2825 - 012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor