Gerondale, Bryan R

Gerondale, Bryan R is an individual health care provider with primary practice located at 5306 N Port Washington Rd , Glendale WI 53217-4913. He recently has 2 registered licenses in different health care specialties including Chiropractic Providers / Sports Physician, Chiropractic Providers / Chiropractor. Chiropractic Providers / Sports Physician is his primary health care specialty. Gerondale, Bryan R can be contacted via phone (414) 332-0859.

Contact Information

Primary practice address
5306 N Port Washington Rd Glendale WI 53217-4913
Phone: (414) 332-0859
Fax: (414) 332-3991
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Sports Physician 111NS0005X 1776-012 Wisconsin
Chiropractic Providers / Chiropractor 111N00000X 1776-12 Wisconsin

Profile Details

NPI number 1598852147
LBN Legal business name Gerondale, Bryan R
Credentials Doctor of Chiropractic (DC)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 6th, 2006
Last updated Apr 4th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598852147 NPPES
Wisconsin MEDICAID 38776000

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