Provider Demographics
NPI:1467507160
Name:DR. LIZ HOOD, S.C.
Entity Type:Organization
Organization Name:DR. LIZ HOOD, S.C.
Other - Org Name:DR. MARNA MOOLLA S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-476-2225
Mailing Address - Street 1:2645 N. MAYFAIR RD.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2239
Mailing Address - Country:US
Mailing Address - Phone:414-476-2225
Mailing Address - Fax:414-476-2805
Practice Address - Street 1:2645 N. MAYFAIR RD.
Practice Address - Street 2:SUITE 140
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2239
Practice Address - Country:US
Practice Address - Phone:414-476-2225
Practice Address - Fax:414-476-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4290-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38732600Medicaid
U52383Medicare UPIN
WI000035635Medicare PIN
WI38732600Medicaid