Provider Demographics
NPI:1447205943
Name:MAHALKO, BEN R (DC)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:R
Last Name:MAHALKO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:N112W15237 MEQUON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3451
Mailing Address - Country:US
Mailing Address - Phone:262-255-7515
Mailing Address - Fax:262-255-7513
Practice Address - Street 1:N112W15237 MEQUON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3451
Practice Address - Country:US
Practice Address - Phone:262-255-7515
Practice Address - Fax:262-255-7513
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4170-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38964400Medicaid