Provider Demographics
NPI:1891897328
Name:LIFESTYLE CHIROPRACTIC & WELLNESS CONNECTION LLC
Entity Type:Organization
Organization Name:LIFESTYLE CHIROPRACTIC & WELLNESS CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-499-3333
Mailing Address - Street 1:1671 HOFFMAN RD STE 170
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6232
Mailing Address - Country:US
Mailing Address - Phone:920-499-3333
Mailing Address - Fax:920-482-5814
Practice Address - Street 1:2301 HOLMGREN WAY STE 1
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5270
Practice Address - Country:US
Practice Address - Phone:715-499-3333
Practice Address - Fax:715-884-7495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3788012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========011OtherBC/BS GROUP PIN