Breyan Radeck DC, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4494012 Issued in WI

Legal business name

BREYAN RADECK DC, LLC

Practice address

2717 N Grandview Blvd Ste 101
Waukesha, WI 53188-1672

Phone

(262) 349-9370

Fax

(262) 349-9729

NPI assigned

Nov 5, 2012

Last updated

Jun 27, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Breyan Radeck, DCNPI 1043453426

Title

Chiropractor

Phone

(262) 349-9370

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Breyan Michelle Radeck, D.C.

  • Chiropractor
  • Waukesha, WI
  • NPI 1043453426
  Medicare reassignment NPD Authorized official
• Bethany Radziwon, DC

  • Chiropractor
  • Wexford, PA
  • NPI 1689255614
  NPD
• Heather Ann Rogers King, DC

  • Chiropractor
  • Waukesha, WI
  • NPI 1912089228
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561593600000",
    "number": "1043564610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2717 N GRANDVIEW BLVD STE 101",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881672",
            "telephone_number": "262-349-9370",
            "fax_number": "262-349-9729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2717 N GRANDVIEW BLVD STE 101",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881672",
            "telephone_number": "262-349-9370",
            "fax_number": "262-349-9729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREYAN RADECK DC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-05",
        "last_updated": "2019-06-27",
        "status": "A",
        "authorized_official_last_name": "RADECK",
        "authorized_official_first_name": "BREYAN",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "262-349-9370",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4494012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043453426",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ginny Brennan
• Paul Christopher Brennan, BA
• Jyl Brentana, MS, ATR-BC
• Stephanie Breslow, APNP
• Natalie Brey
• Bridges Home Healthcare LLC (Bridges Home Healthcare)
• Brighter Behaviors, LLC.
• Catherine Bril, PA
• Sarah J Brill
• Amber Nicole Bristle, RDH

• Chiropractor in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.