Provider Demographics
NPI:1770662876
Name:BIESE, LYNN A (DC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:BIESE
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 1:618 55TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140
Mailing Address - Country:US
Mailing Address - Phone:262-657-8434
Mailing Address - Fax:262-657-8435
Practice Address - Street 1:618 55TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140
Practice Address - Country:US
Practice Address - Phone:262-657-8434
Practice Address - Fax:262-657-8435
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2628-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391777152011OtherBCBS WI
WI391777152011OtherBCBS WI
WIU38518Medicare UPIN