Organization
OTT CHIROPRACTIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY D. OTT D.O. (PRESIDENT)
(262) 695-9698
Entity
Organization
Contact information
Practice address
601 RYAN ST, PEWAUKEE, WI 53072-1844
(262) 695-9698
(262) 695-0144
Mailing address
601 RYAN ST, PEWAUKEE, WI 53072-1844
(262) 695-9698
(262) 695-0144
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3063
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000070728
MEDICARE ID
WI
05
—
38881500
—
WI
Enumeration date
10/14/2008
Last updated
11/26/2008
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