Healthcare Provider Details

I. General information

NPI: 1487316634
Provider Name (Legal Business Name): MSK HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E GREENFIELD AVE
MILWAUKEE WI
53204-2966
US

IV. Provider business mailing address

430 E ESTATES PL
OAK CREEK WI
53154-5122
US

V. Phone/Fax

Practice location:
  • Phone: 414-220-0106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MAGGIE MAY KASTEN
Title or Position: OWNER
Credential: D.C.
Phone: 414-430-7005