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General NPI Number Information
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NPI Number | 1023350642
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Entity Type | Organization
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Legal Business Name | THRIVE FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | N88W16644 APPLETON AVE
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-2853
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Country | US
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Telephone | 262-255-6250
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Fax | 262-255-4844
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Provider Business Mailing Address
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Address Line | N88W16644 APPLETON AVE
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-2853
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Country | US
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Telephone | 262-255-6250
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Fax | 262-255-4844
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | TRISTA M BRINGA
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Credential | D.C.
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Telephone | 262-689-4203
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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 | 4896-12
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License Number State | WI
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