Provider Demographics
NPI:1861542284
Name:TRAUTMAN, BRIAN J (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:TRAUTMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2910
Mailing Address - Country:US
Mailing Address - Phone:262-633-6235
Mailing Address - Fax:262-633-6326
Practice Address - Street 1:5332 SPRING ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-2910
Practice Address - Country:US
Practice Address - Phone:262-633-6235
Practice Address - Fax:262-633-6326
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4047-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38958200Medicaid
WI38958200Medicaid