Provider Demographics
NPI:1710096326
Name:KAESKE, LAURA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNN
Last Name:KAESKE
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 1:1810 N DELANY ROAD
Mailing Address - Street 2:SUITE K
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-623-4100
Mailing Address - Fax:847-623-9582
Practice Address - Street 1:1810 N DELANY ROAD
Practice Address - Street 2:SUITE K
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-623-4100
Practice Address - Fax:847-623-9582
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5091110OtherAETNA
IL211141Medicare ID - Type Unspecified
IL5091110OtherAETNA
U52947Medicare UPIN