Provider Demographics
NPI:1184158974
Name:INFINITE ATHLETE CHIROPRACTIC & REHAB LLC
Entity type:Organization
Organization Name:INFINITE ATHLETE CHIROPRACTIC & REHAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-720-1144
Mailing Address - Street 1:5964 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5311
Mailing Address - Country:US
Mailing Address - Phone:608-720-1144
Mailing Address - Fax:
Practice Address - Street 1:5964 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5311
Practice Address - Country:US
Practice Address - Phone:608-720-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5222-12111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty