Provider Demographics
NPI:1689863672
Name:LAUGHLIN, DANE ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:ERIC
Last Name:LAUGHLIN
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 1:1810 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2550
Mailing Address - Country:US
Mailing Address - Phone:715-394-5645
Mailing Address - Fax:715-394-5645
Practice Address - Street 1:1810 N 16TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2550
Practice Address - Country:US
Practice Address - Phone:715-394-5645
Practice Address - Fax:715-394-5645
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2592-012111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38852700Medicaid
WIU25085Medicare UPIN