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General NPI Number Information
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NPI Number | 1831521053
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Entity Type | Organization
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Legal Business Name | SPINAL HEALTH AND CORRECTION CENTER
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Dates
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Enumeration Date | 07/30/2013
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 1468 N HIGH POINT RD
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City | MIDDLETON
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State | WI
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Zip | 53562-3683
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Country | US
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Telephone | 608-833-7422
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Fax | 608-833-7421
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Provider Business Mailing Address
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Address Line | 1468 N HIGH POINT RD
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City | MIDDLETON
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State | WI
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Zip | 53562-3683
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Country | US
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Telephone | 608-833-7422
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRENT D. KOWALKE
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Credential | D.C.
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Telephone | 608-434-0834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4240012
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License Number State | WI
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