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General NPI Number Information
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NPI Number | 1508072836
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Entity Type | Organization
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Legal Business Name | LP CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 5703 75TH ST
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City | KENOSHA
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State | WI
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Zip | 53142-3603
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Country | US
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Telephone | 262-697-1363
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Fax | 262-697-1388
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Provider Business Mailing Address
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Address Line | 5703 75TH ST
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City | KENOSHA
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State | WI
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Zip | 53142-3603
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Country | US
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Telephone | 262-697-1363
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Fax | 262-697-1388
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Authorized Official
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Title or Position | BILLING
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Name | ROBIN NELSON
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Credential |
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Telephone | 262-697-1363
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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 | 11N00000X
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License Number State | WI
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