MEDICARE: SPINEWORKS DECOMPRESSION & 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	305S00000X	Point of Service	3840-012	WI

General Provider Information

NPI Number	:	1508023417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINEWORKS DECOMPRESSION & CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	925 MILWAUKEE AVE
Second Line	:	SUITE A
City	:	BURLINGTON
State	:	WI
Zip	:	53105-1351
Country	:	US
Telephone Number	:	262-763-5800
Fax Number	:	262-763-5815

Provider Business Practice Location Address
First Line	:	925 MILWAUKEE AVE
Second Line	:	SUITE A
City	:	BURLINGTON
State	:	WI
Zip	:	53105-1351
Country	:	US
Telephone Number	:	262-763-5800
Fax Number	:	262-763-5815

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	TROY BRUESEWITZ
Credential	:	DC
Telephone Number	:	262-763-5800

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/13/2020

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