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Contact Information

ACTIVE LIFESTYLE CHIROPRACTIC,SC
140 N. TOWNLINE RD.
WAUTOMA, WI54982-0246
 Phone: 920-787-0122
 Fax: 920-787-0091
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Chiropractor

111N00000X 35 Chiropractic
Indicates primary specialty

NPI Profile & details for ACTIVE LIFESTYLE CHIROPRACTICSC · (Female)

NPI Number 1194801191
Status Active
Credentials
Entity Individual
Enumeration date 10/31/2006
Last updated 08/22/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • WI License # 3391
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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