Provider Demographics
NPI:1548811805
Name:LOTUS FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LOTUS FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KLOES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-530-4080
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:WI
Mailing Address - Zip Code:54758-0321
Mailing Address - Country:US
Mailing Address - Phone:715-530-4080
Mailing Address - Fax:
Practice Address - Street 1:50618 CHARLES ST
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:WI
Practice Address - Zip Code:54758-7508
Practice Address - Country:US
Practice Address - Phone:715-530-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service