Provider Demographics
NPI:1912075912
Name:BRUESEWITZ, TROY E (DC)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:E
Last Name:BRUESEWITZ
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 1:925 MILWAUKEE AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1351
Mailing Address - Country:US
Mailing Address - Phone:262-763-5800
Mailing Address - Fax:262-763-5815
Practice Address - Street 1:925 MILWAUKEE AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1351
Practice Address - Country:US
Practice Address - Phone:262-763-5800
Practice Address - Fax:262-763-5815
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3840-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36-4543209OtherEIN
WI36-4543209OtherEIN
WIU10079Medicare UPIN