Provider Demographics
NPI:1215134242
Name:ULTIMATE LIFE CHIROPRACTIC INC.
Entity type:Organization
Organization Name:ULTIMATE LIFE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOEPECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-545-5433
Mailing Address - Street 1:3044 S 92ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-3678
Mailing Address - Country:US
Mailing Address - Phone:414-545-5433
Mailing Address - Fax:414-545-6757
Practice Address - Street 1:3044 S 92ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-3678
Practice Address - Country:US
Practice Address - Phone:414-545-5433
Practice Address - Fax:414-545-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3789-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty