MEDICARE: DR. JONATHAN PAUL MUELLER D.C.

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	2259	WI

General Provider Information

NPI Number	:	1578651808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN PAUL MUELLER D.C.

Provider Business Mailing Address
First Line	:	4818 S 76TH ST
Second Line	:	SUITE 12
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4362
Country	:	US
Telephone Number	:	414-281-7080
Fax Number	:	414-281-7087

Provider Business Practice Location Address
First Line	:	4818 S 76TH ST
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4362
Country	:	US
Telephone Number	:	414-281-7080
Fax Number	:	414-281-7087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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