Provider Demographics
NPI:1144375924
Name:LAU, CHRISTOPHER ROGER (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROGER
Last Name:LAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1737
Mailing Address - Country:US
Mailing Address - Phone:920-361-9917
Mailing Address - Fax:920-361-9894
Practice Address - Street 1:120 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1737
Practice Address - Country:US
Practice Address - Phone:920-361-9917
Practice Address - Fax:920-361-9894
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38927100Medicaid
WIU81442Medicare UPIN
WI38927100Medicaid