Healthcare Provider Details

I. General information

NPI: 1508023417
Provider Name (Legal Business Name): SPINEWORKS DECOMPRESSION & CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 MILWAUKEE AVE SUITE A
BURLINGTON WI
53105-1351
US

IV. Provider business mailing address

925 MILWAUKEE AVE SUITE A
BURLINGTON WI
53105-1351
US

V. Phone/Fax

Practice location:
  • Phone: 262-763-5800
  • Fax: 262-763-5815
Mailing address:
  • Phone: 262-763-5800
  • Fax: 262-763-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number3840-012
License Number StateWI

VIII. Authorized Official

Name: TROY BRUESEWITZ
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 262-763-5800