Provider Demographics
NPI:1043579485
Name:ABSOLUTE CHIROPRACTIC & WELLNESS LLC
Entity Type:Organization
Organization Name:ABSOLUTE CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FOERSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-909-1039
Mailing Address - Street 1:23521 82ND PL
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11300 75TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7308
Practice Address - Country:US
Practice Address - Phone:262-909-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3968-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty