Lakeside Chiropractic LLC
Chiropractor in Kenosha, WI. Organization (NPI-2).
NPI number1669005013
StatusActive
Last updated in NPPESFeb 13, 2020
Details
- NPI
- 1669005013
- Entity type
- Organization (NPI-2)
- Legal business name
- Lakeside Chiropractic LLC
- Organization subpart
- No
- Enumeration date
- Feb 13, 2020
- Certification date
- Feb 13, 2020
- Last updated
- Feb 13, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | – | – | Yes |
Practice location
5024 Green Bay Rd Ste 100Kenosha, WI 53144-1702
Phone 262-657-8434 · Fax 262-657-8435
Mailing address
5024 Green Bay Rd Ste 100Kenosha, WI 53144-1702
Phone 262-657-8434 · Fax 262-657-8435
Authorized official
Jaynie Gossett
Billing Coordinator
2626578434
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