Organization
LICE CLINICS OF AMERICA- NORTHWEST INDIANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDAL KLACKLE (OWNER)
(630) 624-4544
Entity
Organization
Contact information
Practice address
1010 BREUCKMAN DR, CROWN POINT, IN 46307-7530
(219) 779-2289
Mailing address
18909 PARRISH AVE, LOWELL, IN 46356-9618
(630) 624-4544
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
05/02/2018
Last updated
05/02/2018
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