MEDICARE: BLAIR CHIROPRACTIC CENTER, 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	3358-012	WI

General Provider Information

NPI Number	:	1366456709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAIR CHIROPRACTIC CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 66
Second Line	:
City	:	BLAIR
State	:	WI
Zip	:	54616-0066
Country	:	US
Telephone Number	:	608-989-2020
Fax Number	:	608-989-2308

Provider Business Practice Location Address
First Line	:	237 W. BROADWAY
Second Line	:
City	:	BLAIR
State	:	WI
Zip	:	54616
Country	:	US
Telephone Number	:	608-989-2020
Fax Number	:	608-989-2308

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN JAMES BROST
Credential	:	D.C.
Telephone Number	:	608-989-2020

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	08/22/2020

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