Provider Demographics
NPI:1407044811
Name:LIFEFORCE CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:LIFEFORCE CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-633-8160
Mailing Address - Street 1:3204 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-3037
Mailing Address - Country:US
Mailing Address - Phone:262-633-8160
Mailing Address - Fax:262-633-3512
Practice Address - Street 1:3204 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-3037
Practice Address - Country:US
Practice Address - Phone:262-633-8160
Practice Address - Fax:262-633-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty