Healthcare Provider Details

I. General information

NPI: 1275132177
Provider Name (Legal Business Name): BRONWYN HUTCHINSON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KINGS LYNN RD
STOUGHTON WI
53589-1999
US

IV. Provider business mailing address

101 KINGS LYNN RD
STOUGHTON WI
53589-1999
US

V. Phone/Fax

Practice location:
  • Phone: 608-873-9311
  • Fax:
Mailing address:
  • Phone: 608-873-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5564-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: