Organization
VITALITY ENTERPRISES, LLC
Active
Other names
Wussow Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN R WUSSOW D.C. (OWNER)
(608) 833-1114
Entity
Organization
Contact information
Practice address
8434 OLD SAUK RD, MIDDLETON, WI 53562-4367
(608) 833-1114
Mailing address
8434 OLD SAUK RD, MIDDLETON, WI 53562-4367
(608) 833-1114
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000035554
MEDICARE PTAN
WI
Enumeration date
01/08/2007
Last updated
05/21/2013
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