Organization
PEWAUKEE FAMILY CHIROPRACTIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY CRISTOPHER PEARCE (PRESIDENT)
(262) 695-9206
Entity
Organization
Contact information
Practice address
N28W23000 ROUNDY DR STE 101, PEWAUKEE, WI 53072-7300
(262) 695-9206
Mailing address
N28W23000 ROUNDY DR STE 101, PEWAUKEE, WI 53072-7300
(262) 695-9206
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3904-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38955000
—
WI
Enumeration date
01/16/2007
Last updated
05/13/2019
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