MEDICARE: DR. BONNIE JEAN LANGREHR DC

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	2250012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	397687773E07	OTHER	WI	BCBS SERVICING PROVIDER

General Provider Information

NPI Number	:	1699741801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONNIE JEAN LANGREHR DC

Provider Business Mailing Address
First Line	:	4222 MILWAUKEE ST
Second Line	:	83
City	:	MADISON
State	:	WI
Zip	:	53714-3508
Country	:	US
Telephone Number	:	608-222-4244
Fax Number	:	608-222-9341

Provider Business Practice Location Address
First Line	:	4222 MILWAUKEE ST
Second Line	:	83
City	:	MADISON
State	:	WI
Zip	:	53714-3508
Country	:	US
Telephone Number	:	608-222-4244
Fax Number	:	608-222-9341

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	12/21/2022

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