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Organization
KETTLE MORAINE HEALTH & WELLNESS LLC
Active
Organization
KETTLE MORAINE HEALTH & WELLNESS LLC
Active
Other names
United Chiropractic Sports & Reha
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD PHILIP MORTENSEN DOCTOR OF CHIROPRACT (CLINIC DIRECTOR AND OWNER)
(262) 723-3235
Entity
Organization
Contact information
Practice address
422 N WISCONSIN ST STE A, ELKHORN, WI 53121-1318
(262) 723-3235
(262) 723-8621
Mailing address
422 N WISCONSIN ST STE A, ELKHORN, WI 53121-1318
(262) 723-3235
(262) 723-8621
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
38010724
IL
111N00000X
Chiropractor
Primary
3859-012
WI
111N00000X
Chiropractor
4229
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38943900
—
WI
05
—
39004100
—
WI
01
—
390747208005
BCBS DR. TODDS PIN
WI
01
—
776235397018
BCBS CLINIC
WI
Enumeration date
01/15/2007
Last updated
02/07/2011
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