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General NPI Number Information
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NPI Number | 1992136709
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Entity Type | Organization
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Legal Business Name | MIDWEST RELIEF AND REHAB
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 17145 W BLUEMOUND RD STE J #260
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City | BROOKFIELD
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State | WI
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Zip | 53005-5941
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Country | US
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Telephone | 262-745-7420
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Fax |
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Provider Business Mailing Address
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Address Line | 17145 W BLUEMOUND RD STE J #260
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City | BROOKFIELD
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State | WI
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Zip | 53005-5941
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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 | CHIROPRACTOR
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Name | PETER GEARY
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Credential | DC
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Telephone | 262-745-7420
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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 | 4610-12
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License Number State | WI
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