Provider Demographics
NPI:1316498850
Name:AFFINITY CHIROPRACTIC & WELLNESS, LLC
Entity type:Organization
Organization Name:AFFINITY CHIROPRACTIC & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-422-6999
Mailing Address - Street 1:259 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4824
Mailing Address - Country:US
Mailing Address - Phone:262-422-6999
Mailing Address - Fax:
Practice Address - Street 1:259 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4824
Practice Address - Country:US
Practice Address - Phone:262-422-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5208-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty