MEDICARE: ISAIAH J GRIESBACH 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	5693-12	WI

General Provider Information

NPI Number	:	1447917703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAIAH J GRIESBACH D.C.

Provider Business Mailing Address
First Line	:	105 MAPLE DR
Second Line	:
City	:	BONDUEL
State	:	WI
Zip	:	54107-9243
Country	:	US
Telephone Number	:	715-851-4461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 E MASON ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-2739
Country	:	US
Telephone Number	:	920-465-0400
Fax Number	:	920-465-1430

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

Provider Enumeration Date	:	11/22/2021
Last Update Date	:	12/30/2022

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