Provider Demographics
NPI:1255928768
Name:GATZKE, MAXIMILLIAN E (DC)
Entity type:Individual
Prefix:DR
First Name:MAXIMILLIAN
Middle Name:E
Last Name:GATZKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510093
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-0093
Mailing Address - Country:US
Mailing Address - Phone:262-785-5515
Mailing Address - Fax:262-785-5525
Practice Address - Street 1:15720 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5119
Practice Address - Country:US
Practice Address - Phone:262-785-5515
Practice Address - Fax:262-785-5525
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5603-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor