Healthcare Provider Details

I. General information

NPI: 1134296197
Provider Name (Legal Business Name): DAVID JPHN POETHKE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N MARKET ST SUITE 125
MILWAUKEE WI
53202-3168
US

IV. Provider business mailing address

1543 SKYLINE DR
CEDARBURG WI
53012-9397
US

V. Phone/Fax

Practice location:
  • Phone: 414-220-9441
  • Fax: 414-223-8490
Mailing address:
  • Phone: 262-375-2172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1852-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: