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NPI Code Detail

MEDICARE: DR. BOB MATTHEW GOUNTIS D.C.

MEDICARE: DR. BOB MATTHEW GOUNTIS 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
1111N00000XChiropractor3517-012WI

General Provider Information

NPI Number : 1477607612
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BOB MATTHEW GOUNTIS D.C.
Provider Business Mailing Address
First Line : 1033 N MAYFAIR RD
Second Line : SUITE 303
City : WAUWATOSA
State : WI
Zip : 53226-3442
Country : US
Telephone Number : 414-778-1455
Fax Number : 414-810-4052
Provider Business Practice Location Address
First Line : 1033 N MAYFAIR RD
Second Line : SUITE 303
City : WAUWATOSA
State : WI
Zip : 53226-3442
Country : US
Telephone Number : 414-778-1455
Fax Number : 414-810-4052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 11/04/2010

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Directions to “ DR. BOB MATTHEW GOUNTIS D.C.” Practice Location

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