Provider Demographics
NPI:1821367798
Name:ADJUST YOUR LIFE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ADJUST YOUR LIFE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-839-3513
Mailing Address - Street 1:2850 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-8862
Mailing Address - Country:US
Mailing Address - Phone:608-839-3513
Mailing Address - Fax:608-839-3533
Practice Address - Street 1:2850 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-8862
Practice Address - Country:US
Practice Address - Phone:608-839-3513
Practice Address - Fax:608-839-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4615-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty