MEDICARE: MR. GARRETT J BRUGGER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4929-12	WI

General Provider Information

NPI Number	:	1003257452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARRETT J BRUGGER D.C.

Provider Business Mailing Address
First Line	:	1624 CLARENCE CT
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-8533
Country	:	US
Telephone Number	:	262-334-4847
Fax Number	:	262-334-5554

Provider Business Practice Location Address
First Line	:	1624 CLARENCE CT
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-8533
Country	:	US
Telephone Number	:	262-334-4847
Fax Number	:	262-334-5554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	07/15/2013

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