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Organization

BRE CHIROPRACTIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BREANNA R BALLWEG DC (CHIROPRACTOR)
(608) 630-9040
Entity
Organization

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
01
W12807
MEDICARE ORGANIZATION PTAN
WI
01
W12807001
MEDICARE PTAN
WI
Enumeration date
03/20/2012
Last updated
08/16/2012
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