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General NPI Number Information
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NPI Number | 1508135708
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Entity Type | Organization
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Legal Business Name | WISCONSIN PAIN & REHAB, LLC
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 2100 N MAYFAIR RD 201
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City | WAUWATOSA
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State | WI
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Zip | 53226-2239
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Country | US
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Telephone | 305-608-9248
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Fax |
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Provider Business Mailing Address
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Address Line | 1670 ISLAND WAY
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City | WESTON
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State | FL
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Zip | 33326-3624
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TODD JASON SUSSMAN
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Credential | DC
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Telephone | 305-608-9248
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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 | CH7456
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License Number State | FL
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