Provider Demographics
NPI:1669779914
Name:ALIGN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ALIGN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-720-6300
Mailing Address - Street 1:328 S BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MANAWA
Mailing Address - State:WI
Mailing Address - Zip Code:54949-9581
Mailing Address - Country:US
Mailing Address - Phone:920-720-6300
Mailing Address - Fax:920-720-6315
Practice Address - Street 1:328 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:MANAWA
Practice Address - State:WI
Practice Address - Zip Code:54949-9581
Practice Address - Country:US
Practice Address - Phone:920-720-6300
Practice Address - Fax:920-720-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4582-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty