MEDICARE: BBGH PARTNERSHIP

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	3166-012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578644068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BBGH PARTNERSHIP

Provider Business Mailing Address
First Line	:	541 KENOSHA ST
Second Line	:
City	:	WALWORTH
State	:	WI
Zip	:	53184-9538
Country	:	US
Telephone Number	:	262-275-1700
Fax Number	:	262-275-8767

Provider Business Practice Location Address
First Line	:	541 KENOSHA ST
Second Line	:
City	:	WALWORTH
State	:	WI
Zip	:	53184-9538
Country	:	US
Telephone Number	:	262-275-1700
Fax Number	:	262-275-8767

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. BERNICE ELLIOTT
Credential	:	D.C.
Telephone Number	:	262-275-1700

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	11/01/2007

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Directions to “BBGH PARTNERSHIP ” Practice Location

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