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General NPI Number Information
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NPI Number | 1174906168
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTH OF MILWAUKEE LLC
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 2323 N MAYFAIR RD SUITE 104
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City | WAUWATOSA
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State | WI
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Zip | 53226-1506
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Country | US
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Telephone | 414-837-4468
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Fax | 414-837-4212
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Provider Business Mailing Address
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Address Line | 2323 N MAYFAIR RD SUITE 104
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City | WAUWATOSA
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State | WI
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Zip | 53226-1506
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Country | US
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Telephone | 414-837-4468
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Fax | 414-837-4212
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY BONIKOWSKE
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Credential | D.C.
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Telephone | 414-837-4468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 4606-012
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License Number State | WI
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