Provider Demographics
NPI:1346671039
Name:ALIGNED MODERN WELLNESS LLC
Entity Type:Organization
Organization Name:ALIGNED MODERN WELLNESS LLC
Other - Org Name:RADEMAKER FAMILY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-235-8740
Mailing Address - Street 1:6278 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2527
Mailing Address - Country:US
Mailing Address - Phone:414-235-8740
Mailing Address - Fax:414-435-3129
Practice Address - Street 1:6278 S 108TH ST
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2527
Practice Address - Country:US
Practice Address - Phone:414-235-8740
Practice Address - Fax:414-435-3129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3746-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI016310003OtherPTAN
WI38938300Medicaid
WIU84668Medicare UPIN
WI38938300Medicaid