Provider Demographics
NPI:1447494174
Name:LIFE COMPASS CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:LIFE COMPASS CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:KLOS-MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-290-0379
Mailing Address - Street 1:115 WATERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1525
Mailing Address - Country:US
Mailing Address - Phone:218-290-0379
Mailing Address - Fax:
Practice Address - Street 1:115 WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1525
Practice Address - Country:US
Practice Address - Phone:218-290-0379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4467-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty