Healthcare Provider Details

I. General information

NPI: 1083793459
Provider Name (Legal Business Name): BRIAN JAMES MARKGREN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 S. HASTINGS WAY
EAU CLAIRE WI
54701
US

IV. Provider business mailing address

824 S. HASTINGS WAY
EAU CLAIRE WI
54701
US

V. Phone/Fax

Practice location:
  • Phone: 715-835-1122
  • Fax:
Mailing address:
  • Phone: 715-835-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2981-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: