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General NPI Number Information
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NPI Number | 1427361120
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Entity Type | Organization
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Legal Business Name | LACKMAN CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 4001 RIB MOUNTAIN DR
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City | WAUSAU
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State | WI
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Zip | 54401-7445
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Country | US
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Telephone | 715-571-2702
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 RIB MOUNTAIN DR
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City | WAUSAU
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State | WI
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Zip | 54401-7445
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Country | US
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Telephone | 715-571-2702
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR, OWNER
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Name | ZARA LACKMAN
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Credential | D.C., D.I.C.C.P.
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Telephone | 715-571-2702
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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 | 3393-012
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | 3393-012
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License Number State | WI
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