1932411873 NPI number — INSPIRING VITALITY WELLNESS INSTITUTE LLC

Table of content: (NPI 1932411873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932411873 NPI number — INSPIRING VITALITY WELLNESS INSTITUTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSPIRING VITALITY WELLNESS INSTITUTE 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:
1932411873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2920 ENLOE ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54016-8190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-808-0716
Provider Business Mailing Address Fax Number:
715-808-0807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2920 ENLOE ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54016-8190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-808-0716
Provider Business Practice Location Address Fax Number:
715-808-0807
Provider Enumeration Date:
07/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
DARYL
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
715-808-0716

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 1664-012 , 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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