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Contact Information

BRYAN R GERONDALE, D.C.
5306 N PORT WASHINGTON RD
GLENDALE, WI53217-4913
 Phone: 414-332-0859
 Fax: 414-332-3991
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Physician

111NS0005X 35 Chiropractic
 

Chiropractor

111N00000X 35 Chiropractic
Indicates primary specialty

NPI Profile & details for BRYAN R GERONDALE · (Male)

NPI # 1598852147
Status Active
Credentials D.C. (Doctor of Chiropractic)
Entity Individual
Enumeration date 10/06/2006
Last updated 04/04/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 1776-012
  • WI License # 1776-12
  • WI Medicaid 38776000
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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