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General NPI Number Information
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NPI Number | 1003000688
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Entity Type | Organization
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Legal Business Name | HUSSKE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 1265 COFFEEN AVE
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City | SHERIDAN
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State | WY
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Zip | 82801-5325
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Country | US
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Telephone | 307-674-7433
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Fax | 307-674-6808
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Provider Business Mailing Address
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Address Line | 1265 COFFEEN AVE
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City | SHERIDAN
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State | WY
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Zip | 82801-5325
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Country | US
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Telephone | 307-674-7433
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Fax | 307-674-6808
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | MR. BRIAN A HUSSKE
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Credential | D.C, C.C.S.P.
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Telephone | 307-674-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 488
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License Number State | WY
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