Organization
DR. DAVID L. BROUILLETTE, D.C., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID L. BROUILLETTE D.C. (PRESIDENT)
(262) 692-6747
Entity
Organization
Contact information
Practice address
511 FREDONIA AVE, FREDONIA, WI 53021-9406
(262) 692-6747
(262) 692-6547
Mailing address
511 FREDONIA AVE, FREDONIA, WI 53021-9406
(262) 692-6747
(262) 692-6547
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2907
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245234772
NPI # TYPE 1
WI
Enumeration date
01/15/2007
Last updated
08/22/2020
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