Healthcare Provider Details

I. General information

NPI: 1710096326
Provider Name (Legal Business Name): LAURA LYNN KAESKE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA KAESKE NIEDER DC

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 WAUKEGAN RD STE 100
BANNOCKBURN IL
60015-1836
US

IV. Provider business mailing address

1132 OXFORD RD
DEERFIELD IL
60015-3325
US

V. Phone/Fax

Practice location:
  • Phone: 847-236-1194
  • Fax: 847-236-1195
Mailing address:
  • Phone: 847-607-8561
  • Fax: 847-236-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007864
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: