Provider Demographics
NPI:1831521053
Name:SPINAL HEALTH AND CORRECTION CENTER
Entity type:Organization
Organization Name:SPINAL HEALTH AND CORRECTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOWALKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-434-0834
Mailing Address - Street 1:1468 N HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3683
Mailing Address - Country:US
Mailing Address - Phone:608-833-7422
Mailing Address - Fax:
Practice Address - Street 1:1468 N HIGH POINT RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3683
Practice Address - Country:US
Practice Address - Phone:608-833-7422
Practice Address - Fax:608-833-7421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4240012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty