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General NPI Number Information
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NPI Number | 1346671039
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Entity Type | Organization
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Legal Business Name | ALIGNED MODERN WELLNESS LLC
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 6278 S 108TH ST
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City | HALES CORNERS
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State | WI
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Zip | 53130-2527
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Country | US
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Telephone | 414-235-8740
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Fax | 414-435-3129
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Provider Business Mailing Address
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Address Line | 6278 S 108TH ST
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City | HALES CORNERS
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State | WI
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Zip | 53130-2527
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Country | US
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Telephone | 414-235-8740
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Fax | 414-435-3129
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Authorized Official
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Title or Position | OWNER
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Name | DR. TREVA RADEMAKER
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Credential | DC
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Telephone | 414-235-8740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3746-12
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License Number State | WI
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