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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 CHIROPRACTIC,SC

NPI # 1194801191
LBN Legal business name ACTIVE LIFESTYLE CHIROPRACTIC,SC
Authorized official DAVID GRUSZKA - (DOCTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 10/31/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
WI License # 3391
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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