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General NPI Number Information
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NPI Number | 1447754890
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Entity Type | Organization
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Legal Business Name | ALIVE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 12930 W BLUEMOUND RD
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City | ELM GROVE
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State | WI
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Zip | 53122-2606
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Country | US
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Telephone | 262-955-8867
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Fax |
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Provider Business Mailing Address
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Address Line | 12930 W BLUEMOUND RD
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City | ELM GROVE
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State | WI
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Zip | 53122-2606
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Country | US
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Telephone | 262-955-8867
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ROBERT W FUGIEL
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Credential | DC
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Telephone | 262-955-8867
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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 | 5317-12
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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