Healthcare Provider Details

I. General information

NPI: 1174551816
Provider Name (Legal Business Name): MAHALKO FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N112W15237 MEQUON RD SUITE 200
GERMANTOWN WI
53022-3451
US

IV. Provider business mailing address

N112W15237 MEQUON RD SUITE 200
GERMANTOWN WI
53022-3451
US

V. Phone/Fax

Practice location:
  • Phone: 262-255-7515
  • Fax: 262-255-7513
Mailing address:
  • Phone: 262-255-7515
  • Fax: 262-255-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BEN R MAHALKO
Title or Position: CO-OWNER/DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 262-255-7515