Provider Demographics
NPI:1831526581
Name:DREWICZ WELLNESS, LLC
Entity type:Organization
Organization Name:DREWICZ WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DREWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-305-5869
Mailing Address - Street 1:17100 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5950
Mailing Address - Country:US
Mailing Address - Phone:262-402-6740
Mailing Address - Fax:262-402-6741
Practice Address - Street 1:17100 W BLUEMOUND RD
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5950
Practice Address - Country:US
Practice Address - Phone:262-402-6740
Practice Address - Fax:262-402-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty