Provider Demographics
NPI:1992136709
Name:MIDWEST RELIEF AND REHAB
Entity type:Organization
Organization Name:MIDWEST RELIEF AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-745-7420
Mailing Address - Street 1:17145 W BLUEMOUND RD STE J
Mailing Address - Street 2:#260
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17145 W BLUEMOUND RD STE J
Practice Address - Street 2:#260
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5941
Practice Address - Country:US
Practice Address - Phone:262-745-7420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4610-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty