Brianna Blanck-Grott, D.C.
Individual provider Active NPI Chiropractor · Crivitz, WI
NPI 1831587633 · NPPES record last updated May 2, 2018
Key facts
- NPI
- 1831587633
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5051 (WI)
- Practice address
- 709 Dyer St
Crivitz, WI 54114-7480 - Phone
- (715) 854-5025
- Fax
- (866) 323-0252
- NPI assigned
- Dec 31, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5051 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peterson Chiropractic Family Wellness Centre, S.C. | Past |
Accepting new patients | |
| Northern Chiropractic and Wellness LLC | Chiropractor | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038012744 | IL | |
| Chiropractor | 111N00000X | 5051-12 | WI | |
| Chiropractor | 111N00000X | 5051 | WI | Yes |
Addresses
Primary practice location
709 Dyer St
Crivitz, WI 54114-7480
Mailing address
PO Box 593
Crivitz, WI 54114-0593
Phone (715) 854-5025
Other names
- Brianna Ludeking
Other providers in Crivitz, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.