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General NPI Number Information
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NPI Number | 1730657230
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Entity Type | Organization
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Legal Business Name | BRICE WILTGEN D.C., PLLC
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 15288 W BROOKSIDE LN STE 139
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City | SURPRISE
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State | AZ
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Zip | 85374-3990
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Country | US
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Telephone | 623-544-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 15288 W BROOKSIDE LN STE 139
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City | SURPRISE
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State | AZ
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Zip | 85374-3990
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Country | US
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Telephone | 623-544-4444
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. BRICE WILTGEN
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Credential | DC
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Telephone | 308-440-9821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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