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N72 W28550 Sussex Road, Merton, WI 53056 | |
(262) 538-1628 | |
(262) 538-1630 |
Full Name | |
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Type | Facility |
Speciality | Chiropractor |
Location | N72 W28550 Sussex Road, Merton, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1558458026 | NPI | - | NPPES |
1891809422 | Other | NPI |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | 2171 (Wisconsin) | Primary |
Provider Name | Russell R Hauser |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1891809422 PECOS PAC ID: 8628035516 Enrollment ID: I20041213000395 |
Provider Name | Jesse Cullen Braun |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1083645667 PECOS PAC ID: 5597763326 Enrollment ID: I20061110000073 |
Provider Name | Benjamin A Luczak |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1093044133 PECOS PAC ID: 0547392839 Enrollment ID: I20100722000364 |
Mailing Address | Practice Location Address |
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N72 W28550 Sussex Road, Hartland, WI 53029 Ph: (262) 538-1628 | N72 W28550 Sussex Road, Merton, WI 53056 Ph: (262) 538-1628 |