Healthcare Provider Details

I. General information

NPI: 1457020323
Provider Name (Legal Business Name): MEQUON FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6617 W MEQUON RD UNIT A
MEQUON WI
53092-1834
US

IV. Provider business mailing address

6617 W MEQUON RD UNIT A
MEQUON WI
53092-1834
US

V. Phone/Fax

Practice location:
  • Phone: 262-444-3545
  • Fax:
Mailing address:
  • Phone: 262-444-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BRITTANY WOLFMEYER IGWIKE
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 414-364-0833