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General NPI Number Information
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NPI Number | 1477879468
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Entity Type | Organization
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Legal Business Name | GATEWAY CHIROPRACTIC AND REHABILITATION LLC
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 1166 QUAIL CT SUITE 315
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City | PEWAUKEE
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State | WI
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Zip | 53072-3769
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Country | US
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Telephone | 262-691-7562
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Fax | 262-691-7572
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Provider Business Mailing Address
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Address Line | 1166 QUAIL CT SUITE 315
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City | PEWAUKEE
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State | WI
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Zip | 53072-3769
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Country | US
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Telephone | 262-691-7562
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Fax | 262-691-7572
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN WEXLER
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Credential | D.C
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Telephone | 262-691-7562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 4403-012
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 4403-012
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License Number State | WI
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