Provider Demographics
NPI:1871399204
Name:TRUCKENBROD, NEIL (DC)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:TRUCKENBROD
Suffix:
Gender:
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:W9037 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53114-1257
Mailing Address - Country:US
Mailing Address - Phone:262-374-4512
Mailing Address - Fax:
Practice Address - Street 1:N144W6220 PIONEER RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2723
Practice Address - Country:US
Practice Address - Phone:262-377-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6276-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor