Provider Demographics
NPI:1730724899
Name:DISC CENTERS OF AMERICA - BROOKFIELD, LLC
Entity type:Organization
Organization Name:DISC CENTERS OF AMERICA - BROOKFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-246-3000
Mailing Address - Street 1:N14W23833 STONE RIDGE DR STE 360
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1125
Mailing Address - Country:US
Mailing Address - Phone:262-246-3000
Mailing Address - Fax:262-910-4945
Practice Address - Street 1:N14W23833 STONE RIDGE DR STE 360
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1125
Practice Address - Country:US
Practice Address - Phone:262-246-3000
Practice Address - Fax:262-910-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty