Provider Demographics
NPI:1457372187
Name:VARICHAK, BRYAN (DC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:VARICHAK
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:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-0783
Mailing Address - Country:US
Mailing Address - Phone:608-781-2225
Mailing Address - Fax:608-781-2225
Practice Address - Street 1:1020 W WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2230
Practice Address - Country:US
Practice Address - Phone:608-269-8145
Practice Address - Fax:608-269-8147
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2743-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00600198OtherMEDICARE RAILROAD
WI38860300Medicaid
WIP00600198OtherMEDICARE RAILROAD
WIU24314Medicare UPIN
WI38860300Medicaid