Provider Demographics
NPI:1487714408
Name:ZUPANCICH, BRADLEY J (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:ZUPANCICH
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 1:4058 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8425
Mailing Address - Country:US
Mailing Address - Phone:952-454-1842
Mailing Address - Fax:
Practice Address - Street 1:4000 STATE ROAD 16 - VALLEY VIEW MALL ANNEX
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-1809
Practice Address - Country:US
Practice Address - Phone:608-784-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4201-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor