Provider Demographics
NPI:1508403213
Name:KAISER CHIROPRACTIC CLINIC 11 LLC
Entity Type:Organization
Organization Name:KAISER CHIROPRACTIC CLINIC 11 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-864-7967
Mailing Address - Street 1:322 E US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2654
Mailing Address - Country:US
Mailing Address - Phone:219-864-7967
Mailing Address - Fax:
Practice Address - Street 1:322 E US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2654
Practice Address - Country:US
Practice Address - Phone:219-864-7967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty