Life Clinic of Wi SC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

LIFE CLINIC OF WI SC

Practice address

17585 Golf Pkwy
Brookfield, WI 53045-2948

Phone

(952) 229-7464

NPI assigned

Oct 25, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Reza AlizadehNPI 1538214598

Title

Owner

Phone

(612) 868-6894

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Reza Pour Alizadeh, D.C.

  • Chiropractor
  • Saint Paul, MN
  • NPI 1538214598
  NPD (past) Authorized official
• Ross Oldenburg, DC

  • Chiropractor
  • Shorewood, WI
  • NPI 1528714102
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1295378875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553170549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17585 GOLF PKWY",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530452948",
            "telephone_number": "952-229-7464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CLINIC OF WI SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-25",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "ALIZADEH",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-868-6894"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• LH Counseling
• LHCG Xlvii, LLC (Wisconsin Home Health)
• Juan Li
• Christopher Lieb, MD
• Diane Joan Liewen, SLP
• Life-Span Psychological Services, LLC (Life-Span Family Services)
• Lifelink Behavioral Health
• Lifesaving Academy (Lifesaving Academy llc)
• Lifespan Family Services
• Lifespan Psychological Health Cooperative

• Chiropractor in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.