Organization
NORTHWEST CHIROPRACTIC AND SPORTS REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON MICHAEL LANGERUDE DC (OWNER)
(715) 637-3000
Entity
Organization
Contact information
Practice address
1151 E DIVISION AVE STE A, BARRON, WI 54812
(715) 637-3000
Mailing address
1151 E DIVISION AVE STE A, BARRON, WI 54812-1234
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5380-12
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100082273
—
WI
Enumeration date
08/21/2018
Last updated
03/05/2019
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