Healthcare Provider Details

I. General information

NPI: 1891490496
Provider Name (Legal Business Name): MARITIME CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E REED AVE
MANITOWOC WI
54220-2121
US

IV. Provider business mailing address

645 W RIDGEVIEW DR
APPLETON WI
54911-1254
US

V. Phone/Fax

Practice location:
  • Phone: 920-682-1111
  • Fax:
Mailing address:
  • Phone: 920-997-9740
  • Fax: 920-997-9748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRENT A BUSS
Title or Position: DOCTOR/MEMBER/OWNER
Credential: DC
Phone: 920-997-9740