1083947410 NPI number — SPRINGTIME HEALTH AND WELLNESS, SC

Table of content: (NPI 1083947410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083947410 NPI number — SPRINGTIME HEALTH AND WELLNESS, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGTIME HEALTH AND WELLNESS, SC
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:
SPRINGTIME CHIROPRACTIC SC
Provider Other Organization Name Type Code:
5
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:
1083947410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 S WHITNEY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53711-6274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-274-6200
Provider Business Mailing Address Fax Number:
608-278-4586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 S WHITNEY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53711-6274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-274-6200
Provider Business Practice Location Address Fax Number:
608-278-4586
Provider Enumeration Date:
09/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LENZ
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
LENZ
Authorized Official Title or Position:
OWNER/ CHIROPRACTOR
Authorized Official Telephone Number:
608-274-6200

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NP0017X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NS0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1871569939 . This is a "IND NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1740251644 . This is a "IND NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1932486370 . This is a "IND NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1679771760 . This is a "IND NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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