Provider Demographics
NPI:1619185774
Name:LORENZ CHIROPRACTIC INC
Entity Type:Organization
Organization Name:LORENZ CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-784-2227
Mailing Address - Street 1:432 CASS ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4508
Mailing Address - Country:US
Mailing Address - Phone:608-784-2227
Mailing Address - Fax:608-784-2439
Practice Address - Street 1:432 CASS ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4508
Practice Address - Country:US
Practice Address - Phone:608-784-2227
Practice Address - Fax:608-784-2439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2648-012111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI389-979-00Medicaid
WI389-979-00Medicaid