MEDICARE: DR. BRADLEY H WEHKING 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	3149	WI

General Provider Information

NPI Number	:	1306834130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY H WEHKING D.C.

Provider Business Mailing Address
First Line	:	816 WEST ST
Second Line	:
City	:	WATERTOWN
State	:	WI
Zip	:	53094-3608
Country	:	US
Telephone Number	:	920-262-0200
Fax Number	:	920-262-0210

Provider Business Practice Location Address
First Line	:	816 WEST ST
Second Line	:
City	:	WATERTOWN
State	:	WI
Zip	:	53094-3608
Country	:	US
Telephone Number	:	920-262-0200
Fax Number	:	920-262-0210

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	12/14/2023

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