Organization
WISCONSIN SPINAL REHABILITATION CENTER, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH VASQUEZ (OFFICE MANAGER)
(262) 695-1870
Entity
Organization
Contact information
Practice address
21180 W CAPITOL DR, BROOKFIELD, WI 53072-2915
(262) 695-1870
(262) 695-1872
Mailing address
21180 W CAPITOL DR, BROOKFIELD, WI 53072-2915
(262) 695-1870
(262) 695-1872
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
3022
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
387584681E07
ANTHEM BLUE CROSS BLUE SHIELD
WI
Enumeration date
11/11/2009
Last updated
01/13/2020
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