Provider Demographics
NPI:1700288537
Name:FOTI CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FOTI CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-259-9008
Mailing Address - Street 1:11717 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2131
Mailing Address - Country:US
Mailing Address - Phone:414-259-9008
Mailing Address - Fax:414-259-9828
Practice Address - Street 1:11717 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2131
Practice Address - Country:US
Practice Address - Phone:414-259-9008
Practice Address - Fax:414-259-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1394-12111N00000X
WI4400-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty