1437489416 NPI number — EMERSON CHIROPRACTIC WELLNESS CENTER LLC

Table of content: LIERETTE GAIL CORPUZ ONTIVEROS (NPI 1245915065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437489416 NPI number — EMERSON CHIROPRACTIC WELLNESS CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERSON CHIROPRACTIC WELLNESS CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437489416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8499 STATE HIGHWAY 42
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISH CREEK
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54212-9419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-868-9280
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8499 STATE HIGHWAY 42
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FISH CREEK
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54212-9419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-868-9280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
EMERSON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
920-868-9280

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  4242-012 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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