Healthcare Provider Details

I. General information

NPI: 1710295837
Provider Name (Legal Business Name): LORENZ CHIROPRACTIC OFFICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BLACKHAWK AVE
PRAIRIE DU CHIEN WI
53821-1528
US

IV. Provider business mailing address

101 E BLACKHAWK AVE PO BOX 206
PRAIRIE DU CHIEN WI
53821-1528
US

V. Phone/Fax

Practice location:
  • Phone: 608-326-2737
  • Fax: 608-326-4735
Mailing address:
  • Phone: 608-326-2737
  • Fax: 608-326-4735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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