Healthcare Provider Details

I. General information

NPI: 1154313492
Provider Name (Legal Business Name): KENNETH WAYNE SCHENK DC, DACRB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E GENEVA ST
ELKHORN WI
53121-1919
US

IV. Provider business mailing address

415 E GENEVA ST
ELKHORN WI
53121-1919
US

V. Phone/Fax

Practice location:
  • Phone: 262-723-2792
  • Fax: 262-723-2892
Mailing address:
  • Phone: 262-723-2792
  • Fax: 262-723-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3201
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: