Provider Demographics
NPI:1407917388
Name:LUTZ CHIROPRACTIC SC
Entity Type:Organization
Organization Name:LUTZ CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-334-5431
Mailing Address - Street 1:2150 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2908
Mailing Address - Country:US
Mailing Address - Phone:262-334-5431
Mailing Address - Fax:262-335-6481
Practice Address - Street 1:2150 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2908
Practice Address - Country:US
Practice Address - Phone:262-334-5431
Practice Address - Fax:262-335-6481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty