Provider Demographics
NPI:1740648997
Name:ALIGN WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ALIGN WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:STUTTGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-897-4561
Mailing Address - Street 1:EP1007 EQUITY RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54484
Mailing Address - Country:US
Mailing Address - Phone:715-897-4561
Mailing Address - Fax:
Practice Address - Street 1:EP1007 EQUITY RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:WI
Practice Address - Zip Code:54484
Practice Address - Country:US
Practice Address - Phone:715-897-4561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5141-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty