MEDICARE: BREDAEL FAMILY CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4087	WI

General Provider Information

NPI Number	:	1437303575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREDAEL FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	195 CENTER DR
Second Line	:	SUITE 102
City	:	LUXEMBURG
State	:	WI
Zip	:	54217-8395
Country	:	US
Telephone Number	:	920-845-5569
Fax Number	:	920-845-5568

Provider Business Practice Location Address
First Line	:	195 CENTER DR
Second Line	:	SUITE 102
City	:	LUXEMBURG
State	:	WI
Zip	:	54217-8395
Country	:	US
Telephone Number	:	920-845-5569
Fax Number	:	920-845-5568

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM JOSEPH BREDAEL
Credential	:	DC
Telephone Number	:	920-845-5569

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	09/24/2012

Similar Medicare Providers

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Practice Location Address:

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1013978832 — DR. LANCE WILLARD KIRCHMAN D.C.
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