Provider Demographics
NPI:1427077718
Name:BRONSTON, LEO J (DC)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:J
Last Name:BRONSTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-0783
Mailing Address - Country:US
Mailing Address - Phone:608-781-2225
Mailing Address - Fax:608-781-6425
Practice Address - Street 1:1202 COUNTY RD PH
Practice Address - Street 2:SUITE 100
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650
Practice Address - Country:US
Practice Address - Phone:608-781-2225
Practice Address - Fax:608-781-6425
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1491-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38766900Medicaid
WI350022982OtherRAILROAD MEDICARE
WI38766900Medicaid
WI$$$$$$$$$008OtherBLUE CROSS OF WI
WI350022982OtherRAILROAD MEDICARE
WI38766900Medicaid