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Organization
JLB,INC
Active
Organization
JLB,INC
Active
Other names
Fontana Family Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY LOGAN BRIA D.C. (CHIROPRACTOR)
(262) 325-7195
Entity
Organization
Contact information
Practice address
450 MILL ST, SUITE 102, FONTANA, WI 53125-1242
(262) 275-5005
Mailing address
450 MILL ST, SUITE 102, FONTANA, WI 53125-1242
(262) 275-5005
(262) 275-5004
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4188-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000054027
MEDICARE
—
05
—
38966200
—
WI
Enumeration date
07/11/2007
Last updated
12/30/2013
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