Individual
DR. BREANNA ROSE BALLWEG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
621 S GAMMON RD, MADISON, WI 53719-1371
(608) 630-9040
(608) 630-9060
Mailing address
621 S GAMMON RD, MADISON, WI 53719-1371
(608) 630-9040
(608) 630-9060
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4875-12
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100022189
—
WI
Enumeration date
03/19/2012
Last updated
08/16/2012
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