Provider Demographics
NPI:1982702544
Name:VANROO, LAURA A (DC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:VANROO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2505 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0441
Mailing Address - Country:US
Mailing Address - Phone:608-756-5225
Mailing Address - Fax:
Practice Address - Street 1:2505 MILTON AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0441
Practice Address - Country:US
Practice Address - Phone:608-756-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3791-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38933000Medicaid
WI38994700OtherMEDICAID GROUP
WI38994700OtherMEDICAID GROUP