Provider Demographics
NPI:1902894744
Name:BROTSKI, JANE E (DC)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:E
Last Name:BROTSKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-3608
Mailing Address - Country:US
Mailing Address - Phone:920-262-0200
Mailing Address - Fax:920-262-0210
Practice Address - Street 1:816 WEST ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3608
Practice Address - Country:US
Practice Address - Phone:920-262-0200
Practice Address - Fax:920-262-0210
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000135820Medicare ID - Type Unspecified
WIU48953Medicare UPIN