MEDICARE: QUEST 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	111N00000X	Chiropractor	3966-012	WI

General Provider Information

NPI Number	:	1720268808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEST CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2337 S RIDGE RD
Second Line	:	SUITE B
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5857
Country	:	US
Telephone Number	:	922-049-7837
Fax Number	:	920-498-8368

Provider Business Practice Location Address
First Line	:	2337 S RIDGE RD
Second Line	:	SUITE B
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5857
Country	:	US
Telephone Number	:	922-049-7837
Fax Number	:	920-498-8368

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. MARK W. KREBSBACH
Credential	:
Telephone Number	:	920-497-8378

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	11/06/2007

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Directions to “QUEST CHIROPRACTIC LLC ” Practice Location

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