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General NPI Number Information
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NPI Number | 1073693008
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Entity Type | Organization
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Legal Business Name | LGN LTD
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1810 N DELANY ROAD SUITE K
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City | GURNEE
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State | IL
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Zip | 60031
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Country | US
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Telephone | 847-623-4100
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Fax | 847-623-9582
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Provider Business Mailing Address
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Address Line | 1810 N DELANY ROAD SUITE K
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City | GURNEE
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State | IL
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Zip | 60031
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Country | US
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Telephone | 847-623-4100
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Fax | 847-623-9582
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. LAURA LYNN KAESKE
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Credential | DC
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Telephone | 847-623-4100
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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 |
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