Healthcare Provider Details

I. General information

NPI: 1568461085
Provider Name (Legal Business Name): BERNARD JOSEPH ERENBERGER JR. DC, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 N JACKSON ST SUITE 150
MILWAUKEE WI
53202-4620
US

IV. Provider business mailing address

732 N. JACKSON STREET SUITE 150
MILWAUKEE WI
53202-4620
US

V. Phone/Fax

Practice location:
  • Phone: 414-272-7250
  • Fax: 414-272-7107
Mailing address:
  • Phone: 414-272-7250
  • Fax: 414-272-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2533012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: