Provider Demographics
NPI:1154595841
Name:LOTUS HEALING ARTS LLC
Entity type:Organization
Organization Name:LOTUS HEALING ARTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ENSWEILER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:715-345-0655
Mailing Address - Street 1:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-0908
Mailing Address - Country:US
Mailing Address - Phone:715-345-0655
Mailing Address - Fax:715-345-0904
Practice Address - Street 1:2610 POST ROAD
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467
Practice Address - Country:US
Practice Address - Phone:715-345-0655
Practice Address - Fax:715-345-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1734-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000090169Medicare PIN