Healthcare Provider Details

I. General information

NPI: 1477879468
Provider Name (Legal Business Name): GATEWAY CHIROPRACTIC AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 QUAIL CT SUITE 315
PEWAUKEE WI
53072-3769
US

IV. Provider business mailing address

1166 QUAIL CT SUITE 315
PEWAUKEE WI
53072-3769
US

V. Phone/Fax

Practice location:
  • Phone: 262-691-7562
  • Fax: 262-691-7572
Mailing address:
  • Phone: 262-691-7562
  • Fax: 262-691-7572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4403-012
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4403-012
License Number StateWI

VIII. Authorized Official

Name: DR. KEVIN WEXLER
Title or Position: OWNER
Credential: D.C
Phone: 262-691-7562