Provider Demographics
NPI:1134211311
Name:BREITBACH DRAGOSH CHIROPRACTIC CLINIC, S.C.
Entity type:Organization
Organization Name:BREITBACH DRAGOSH CHIROPRACTIC CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-766-3741
Mailing Address - Street 1:141 W WISCONSIN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-2123
Mailing Address - Country:US
Mailing Address - Phone:920-766-3741
Mailing Address - Fax:920-759-5050
Practice Address - Street 1:141 W WISCONSIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-2123
Practice Address - Country:US
Practice Address - Phone:920-766-3741
Practice Address - Fax:920-759-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000075500Medicare ID - Type Unspecified
WI000075500Medicare ID - Type Unspecified