Healthcare Provider Details

I. General information

NPI: 1932392982
Provider Name (Legal Business Name): LORENZ CHIROPRACTIC OFFICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W OAK ST
BOSCOBEL WI
53805-1519
US

IV. Provider business mailing address

PO BOX 205
BOSCOBEL WI
53805-0205
US

V. Phone/Fax

Practice location:
  • Phone: 608-375-2411
  • Fax: 608-375-2411
Mailing address:
  • Phone: 608-375-2411
  • Fax: 608-375-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1898
License Number StateWI

VIII. Authorized Official

Name: KARLA K COON
Title or Position: CA
Credential:
Phone: 608-375-2411