Healthcare Provider Details

I. General information

NPI: 1588733083
Provider Name (Legal Business Name): RONALD THADEUS MICHALSKI D.C., FACO, DABCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11407 W BLUEMOUND RD
WAUWATOSA WI
53226-4031
US

IV. Provider business mailing address

11407 W BLUEMOUND RD
WAUWATOSA WI
53226-4031
US

V. Phone/Fax

Practice location:
  • Phone: 414-778-1900
  • Fax: 414-778-1759
Mailing address:
  • Phone: 414-778-1900
  • Fax: 414-778-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number551157
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: