Provider Demographics
NPI:1356434526
Name:KOWALKE, BRENT DAVID (DC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:DAVID
Last Name:KOWALKE
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 1:1468 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:608-833-7421
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4240012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor