Healthcare Provider Details

I. General information

NPI: 1730675026
Provider Name (Legal Business Name): BRYTON ALAN YEPSEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 60TH ST
KENOSHA WI
53140-4099
US

IV. Provider business mailing address

1024 60TH ST
KENOSHA WI
53140-4099
US

V. Phone/Fax

Practice location:
  • Phone: 262-657-7744
  • Fax:
Mailing address:
  • Phone: 262-657-7744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5731-12
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5371-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: