Provider Demographics
NPI:1821130675
Name:POTISK CHIROPRACTIC OFFICE, S.C.
Entity Type:Organization
Organization Name:POTISK CHIROPRACTIC OFFICE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:POTISK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-762-8441
Mailing Address - Street 1:1333 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1150
Mailing Address - Country:US
Mailing Address - Phone:414-762-8441
Mailing Address - Fax:414-762-0755
Practice Address - Street 1:1333 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-1150
Practice Address - Country:US
Practice Address - Phone:414-762-8441
Practice Address - Fax:414-762-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty