Provider Demographics
NPI:1710295837
Name:LORENZ CHIROPRACTIC OFFICE LLC
Entity Type:Organization
Organization Name:LORENZ CHIROPRACTIC OFFICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CA
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-375-2411
Mailing Address - Street 1:101 E BLACKHAWK AVE
Mailing Address - Street 2:PO BOX 206
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-1528
Mailing Address - Country:US
Mailing Address - Phone:608-326-2737
Mailing Address - Fax:608-326-4735
Practice Address - Street 1:101 E BLACKHAWK AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1528
Practice Address - Country:US
Practice Address - Phone:608-326-2737
Practice Address - Fax:608-326-4735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38982500Medicaid
WIT62629Medicare UPIN
WI000075894Medicare PIN