MEDICARE: COTTAGE CHIROPRACTIC LLC

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	3584	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	391956430014	OTHER	WI	BC BS

General Provider Information

NPI Number	:	1215143870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTAGE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	204 W COTTAGE GROVE RD
Second Line	:
City	:	COTTAGE GROVE
State	:	WI
Zip	:	53527-9211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 W COTTAGE GROVE RD
Second Line	:
City	:	COTTAGE GROVE
State	:	WI
Zip	:	53527-9211
Country	:	US
Telephone Number	:	608-839-1172
Fax Number	:

Authorized Official
Title or Position	:	OWNER CHIROPRACTOR
Name	:	DR. BRIAN POCHEL
Credential	:	D.C.
Telephone Number	:	608-839-1172

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

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