Provider Demographics
NPI:1417067414
Name:LAUER, JASON ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ANTHONY
Last Name:LAUER
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:N10W31572 PHYLLIS PKWY
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2632
Mailing Address - Country:US
Mailing Address - Phone:262-646-2384
Mailing Address - Fax:
Practice Address - Street 1:821 MEADOWBROOK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-7314
Practice Address - Country:US
Practice Address - Phone:262-446-0220
Practice Address - Fax:262-446-0219
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3580-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor