Provider Demographics
NPI:1447754890
Name:ALIVE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ALIVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:FUGIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-955-8867
Mailing Address - Street 1:12930 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2606
Mailing Address - Country:US
Mailing Address - Phone:262-955-8867
Mailing Address - Fax:
Practice Address - Street 1:12930 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2606
Practice Address - Country:US
Practice Address - Phone:262-955-8867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5317-12111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1467952135OtherINDIVIDUAL NPI