Provider Demographics
NPI:1699900837
Name:HEALTH4LIFE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:HEALTH4LIFE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-598-4954
Mailing Address - Street 1:2204 N HILLCREST PKWY
Mailing Address - Street 2:STE. 1
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2626
Mailing Address - Country:US
Mailing Address - Phone:715-598-4954
Mailing Address - Fax:
Practice Address - Street 1:2204 N HILLCREST PKWY
Practice Address - Street 2:STE. 1
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2626
Practice Address - Country:US
Practice Address - Phone:715-598-4954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4285-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty