Provider Demographics
NPI:1578890497
Name:LACKMAN, ZARA LITTLE WING (DC, DICCP)
Entity Type:Individual
Prefix:DR
First Name:ZARA
Middle Name:LITTLE WING
Last Name:LACKMAN
Suffix:
Gender:F
Credentials:DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7158
Mailing Address - Country:US
Mailing Address - Phone:715-845-3775
Mailing Address - Fax:715-848-9015
Practice Address - Street 1:2003 ROBIN LN
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7158
Practice Address - Country:US
Practice Address - Phone:715-845-3775
Practice Address - Fax:715-848-9015
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3393-012111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111N00000XChiropractic ProvidersChiropractor