1598820664 NPI number — DR. CASEY CHRISTOPHER BRENNAN GOESSL D.C.

Table of content: DR. CASEY CHRISTOPHER BRENNAN GOESSL D.C. (NPI 1598820664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598820664 NPI number — DR. CASEY CHRISTOPHER BRENNAN GOESSL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENNAN GOESSL
Provider First Name:
CASEY
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOESSL
Provider Other First Name:
CASEY
Provider Other Middle Name:
CHRISTOPHER
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598820664
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 LASER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54025-7430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-247-4009
Provider Business Mailing Address Fax Number:
715-247-3366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 LASER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54025-7430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-247-4009
Provider Business Practice Location Address Fax Number:
715-247-3366
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4271-012 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 38972500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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