Provider Demographics
NPI:1699194514
Name:PURPOSE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PURPOSE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-386-7879
Mailing Address - Street 1:2850 NATIONAL DR # 105
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-6732
Mailing Address - Country:US
Mailing Address - Phone:608-519-5767
Mailing Address - Fax:608-519-5768
Practice Address - Street 1:2850 NATIONAL DR # 105
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-6732
Practice Address - Country:US
Practice Address - Phone:608-519-5767
Practice Address - Fax:608-519-5768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38898200Medicaid
WIP00108135OtherRAILROAD MEDICARE PIN
WI000135915Medicare PIN
WI38898200Medicaid