Provider Demographics
NPI:1578623864
Name:LASKOWSKI, MARIANNE STEPHANIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:STEPHANIE
Last Name:LASKOWSKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N HAVEN RD
Mailing Address - Street 2:STE 4
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2923
Mailing Address - Country:US
Mailing Address - Phone:630-782-6670
Mailing Address - Fax:630-782-6674
Practice Address - Street 1:103 N HAVEN RD
Practice Address - Street 2:STE 4
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2923
Practice Address - Country:US
Practice Address - Phone:630-782-6670
Practice Address - Fax:630-782-6674
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232283OtherBLUE CROSS BLUE SHIELD
IL02232283OtherBLUE CROSS BLUE SHIELD
U82243Medicare UPIN