Provider Demographics
NPI:1770020810
Name:STSA, LLC
Entity Type:Organization
Organization Name:STSA, LLC
Other - Org Name:LIVE ALIGNED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CICHOSZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-519-2519
Mailing Address - Street 1:1438 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2835
Mailing Address - Country:US
Mailing Address - Phone:608-519-2519
Mailing Address - Fax:608-519-2520
Practice Address - Street 1:1438 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2835
Practice Address - Country:US
Practice Address - Phone:563-359-4203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4680-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty