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General NPI Number Information
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NPI Number | 1083772735
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Entity Type | Organization
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Legal Business Name | KETTLE MORAINE HEALTH CENTER, S.C.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 04/02/2023
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Provider Practice Location Address
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Address Line | 2725 HILLSIDE DR STE A
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City | DELAFIELD
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State | WI
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Zip | 53018-2165
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Country | US
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Telephone | 262-646-2123
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Fax | 262-646-5615
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Provider Business Mailing Address
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Address Line | 2725 HILLSIDE DR STE A
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City | DELAFIELD
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State | WI
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Zip | 53018-2165
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Country | US
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Telephone | 262-646-2123
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Fax | 262-646-5615
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. RICHARD ALLEN VENSKE
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Credential | DC
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Telephone | 262-646-2123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 33436
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3384
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License Number State | WI
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