Provider Demographics
NPI:1639881774
Name:BRUSKY, KEVIN GLENN (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GLENN
Last Name:BRUSKY
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:N21W23340 RIDGEVIEW PKWY W STE 110
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1021
Mailing Address - Country:US
Mailing Address - Phone:262-542-4700
Mailing Address - Fax:262-542-7499
Practice Address - Street 1:N21W23340 RIDGEVIEW PKWY W STE 110
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1021
Practice Address - Country:US
Practice Address - Phone:262-542-4700
Practice Address - Fax:262-542-7499
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI6043-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor