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General NPI Number Information
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NPI Number | 1053677187
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Entity Type | Organization
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Legal Business Name | LAKE ZURICH WELLNESS GROUP
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 165 S RAND RD
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City | LAKE ZURICH
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State | IL
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Zip | 60047-2275
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Country | US
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Telephone | 847-550-4094
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Fax | 847-550-4096
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Provider Business Mailing Address
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Address Line | 28010 238TH ST
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City | LE CLAIRE
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State | IA
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Zip | 52753-9126
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Country | US
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Telephone | 847-996-0007
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Fax | 847-996-0007
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN GLAUS
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Credential | D.C.
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Telephone | 847-996-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | IL
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