Healthcare Provider Details

I. General information

NPI: 1972605731
Provider Name (Legal Business Name): ALAN J BASSUENER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 ST JOSEPH AVE SUITE 2
ARCADIA WI
54612
US

IV. Provider business mailing address

308 ST JOSEPH AVE SUITE 2
ARCADIA WI
54612
US

V. Phone/Fax

Practice location:
  • Phone: 608-323-8563
  • Fax: 608-323-8405
Mailing address:
  • Phone: 608-323-8563
  • Fax: 608-323-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3983012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: