Healthcare Provider Details

I. General information

NPI: 1295816700
Provider Name (Legal Business Name): BRIAN CARL HURTGEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W PRAIRIE VIEW RD SUITE 2
CHIPPEWA FALLS WI
54729-3639
US

IV. Provider business mailing address

3324 HOOVER AVE
ALTOONA WI
54720-1028
US

V. Phone/Fax

Practice location:
  • Phone: 715-720-9097
  • Fax: 715-720-6089
Mailing address:
  • Phone: 715-836-7648
  • Fax: 715-720-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1667-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: