Organization
AT-HOME AUTO ACCIDENT TREATMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN FORMOLO D.C. (OWNER)
(262) 682-1101
Entity
Organization
Contact information
Practice address
5800 W NATIONAL AVE, WEST ALLIS, WI 53214-3446
(262) 682-1101
Mailing address
PO BOX 11, MUSKEGO, WI 53150-0011
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3364
WI
Other
Enumeration date
05/08/2013
Last updated
05/08/2013
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