Provider Demographics
NPI:1518542224
Name:GROUNDED ROOTS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GROUNDED ROOTS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-260-8609
Mailing Address - Street 1:4505 VANGUARD DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-6068
Mailing Address - Country:US
Mailing Address - Phone:414-260-8609
Mailing Address - Fax:
Practice Address - Street 1:4505 VANGUARD DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-6068
Practice Address - Country:US
Practice Address - Phone:414-260-8609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty