Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4333 | WI |
N | 111NR0400X | Rehabilitation Chiropractor | 038009183 | IL |
NPI | 1093896698 |
---|---|
Provider Name | Mark M. Gramblicka |
First Address | Milwaukee, WI 53215-2843 |
Second Address | St Francis, WI 53235-6053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 22/11/2021 |