MEDICARE: GURSKE CHIROPRACTIC OFFICE LLC

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	2246012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4361525	OTHER	WI	AETNA
3	656347	OTHER	WI	ACN

General Provider Information

NPI Number	:	1497901334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GURSKE CHIROPRACTIC OFFICE LLC

Provider Business Mailing Address
First Line	:	9217 W. CENTER ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222
Country	:	US
Telephone Number	:	414-771-1968
Fax Number	:	414-771-3465

Provider Business Practice Location Address
First Line	:	9217 W CENTER ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-4516
Country	:	US
Telephone Number	:	414-771-1968
Fax Number	:	414-771-3465

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONN T. GURSKE
Credential	:	D.C.
Telephone Number	:	414-771-1968

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	09/15/2008

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