Healthcare Provider Details

I. General information

NPI: 1699194514
Provider Name (Legal Business Name): PURPOSE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 NATIONAL DR # 105
ONALASKA WI
54650-6732
US

IV. Provider business mailing address

2850 NATIONAL DR # 105
ONALASKA WI
54650-6732
US

V. Phone/Fax

Practice location:
  • Phone: 608-519-5767
  • Fax: 608-519-5768
Mailing address:
  • Phone: 608-519-5767
  • Fax: 608-519-5768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3375
License Number StateWI

VIII. Authorized Official

Name: DR. MARTY LORENTZ
Title or Position: OWNER
Credential: D.C.
Phone: 608-386-7879