Provider Demographics
NPI:1427499342
Name:MIDWEST ALIGNMENT CENTER,LLC
Entity type:Organization
Organization Name:MIDWEST ALIGNMENT CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PUNITA
Authorized Official - Middle Name:SOOD
Authorized Official - Last Name:KUKREJA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-498-6479
Mailing Address - Street 1:PO BOX 90110
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-0110
Mailing Address - Country:US
Mailing Address - Phone:414-247-9005
Mailing Address - Fax:414-247-9004
Practice Address - Street 1:9916 75TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7583
Practice Address - Country:US
Practice Address - Phone:262-764-1673
Practice Address - Fax:262-764-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4889-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty