Healthcare Provider Details

I. General information

NPI: 1447203013
Provider Name (Legal Business Name): BELLEVUE TOTAL HEALTH, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2763 MANITOWOC RD STE B
GREEN BAY WI
54311-6633
US

IV. Provider business mailing address

2763 MANITOWOC RD STE B
GREEN BAY WI
54311-6633
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-8288
  • Fax: 920-468-9887
Mailing address:
  • Phone: 920-468-8288
  • Fax: 920-468-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2502-012
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4214-012
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25884-020
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number1221-033
License Number StateWI

VIII. Authorized Official

Name: BRADLEY J KENNY
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 920-468-8288