Healthcare Provider Details

I. General information

NPI: 1922053503
Provider Name (Legal Business Name): SARA J MAHALKO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
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 Number3993-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: