Provider Demographics
NPI:1699865394
Name:ROMAGNA, BESS M (DC)
Entity type:Individual
Prefix:DR
First Name:BESS
Middle Name:M
Last Name:ROMAGNA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BESS
Other - Middle Name:M
Other - Last Name:GROSSKOPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5751 CHERYL LN
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9131
Mailing Address - Country:US
Mailing Address - Phone:262-384-1274
Mailing Address - Fax:
Practice Address - Street 1:5600 W BROWN DEER RD STE 208
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2346
Practice Address - Country:US
Practice Address - Phone:414-365-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4255-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI389-70900Medicaid
WI000135918Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WI389-70900Medicaid