MEDICARE: DR. DAVID JPHN POETHKE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1852-012	WI

General Provider Information

NPI Number	:	1134296197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JPHN POETHKE D.C.

Provider Business Mailing Address
First Line	:	1543 SKYLINE DR
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-9397
Country	:	US
Telephone Number	:	262-375-2172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 N MARKET ST
Second Line	:	SUITE 125
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3168
Country	:	US
Telephone Number	:	414-220-9441
Fax Number	:	414-223-8490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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