Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 551157 | WI |
NPI | 1588733083 |
---|---|
Provider Name | Dr. Ronald Thadeus Michalski |
First Address | Wauwatosa, WI 53226-4031 |
Second Address | Wauwatosa, WI 53226-4031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 05/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T62765 | (02) | WI |