Dr. David L. Brouillette, D.C., S.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2907 Issued in WI

Legal business name

DR. DAVID L. BROUILLETTE, D.C., S.C.

Practice address

511 Fredonia Ave
Fredonia, WI 53021-9406

Phone

(262) 692-6747

Fax

(262) 692-6547

NPI assigned

Jan 15, 2007

Last updated

Aug 22, 2020By 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. David L. Brouillette, D.C.NPI 1245234772

Title

President

Phone

(262) 692-6747

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

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.

• David L Brouillette, D.C.

  • Chiropractor
  • Fredonia, WI
  • NPI 1245234772
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780735894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 FREDONIA AVE",
            "city": "FREDONIA",
            "state": "WI",
            "postal_code": "530219406",
            "telephone_number": "262-692-6747",
            "fax_number": "262-692-6547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 FREDONIA AVE",
            "city": "FREDONIA",
            "state": "WI",
            "postal_code": "530219406",
            "telephone_number": "262-692-6747",
            "fax_number": "262-692-6547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. DAVID L. BROUILLETTE, D.C., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROUILLETTE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-692-6747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI # TYPE 1",
            "identifier": "1245234772",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Broadstep-Wisconsin, Inc.
• David L Brouillette, D.C.
• Matthew Francis Byers, OD
• Jenna Conforti
• Kristen K Dorman, O.D.
• Fredonia Adult Day Center
• Megan Gavin
• Maggie A Graff, CD
• Keri Gregg, RN
• Payton Heider, RN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.