Provider Demographics
NPI:1174796346
Name:WELLNESS CHIROPRACTIC OF LA CROSSE LLC
Entity type:Organization
Organization Name:WELLNESS CHIROPRACTIC OF LA CROSSE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:HAWKLOVE
Authorized Official - Last Name:INTRILIGATOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-556-0017
Mailing Address - Street 1:2728 ASBURY RD
Mailing Address - Street 2:STE. 500
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-2971
Mailing Address - Country:US
Mailing Address - Phone:563-556-0017
Mailing Address - Fax:
Practice Address - Street 1:2728 ASBURY RD
Practice Address - Street 2:STE. 500
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-2971
Practice Address - Country:US
Practice Address - Phone:563-556-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3628012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty