Organization
LICKTEIG CHIROPRACTIC CLINIC,S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARL ALBERT LICKTEIG D.C. (OWNER)
(262) 240-2273
Entity
Organization
Contact information
Practice address
11649 N PORT WASHINGTON RD, SUITE 100, MEQUON, WI 53092-3460
(262) 240-2273
(262) 240-2260
Mailing address
11649 N PORT WASHINGTON RD, SUITE 100, MEQUON, WI 53092-3460
(262) 240-2273
(262) 240-2260
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2451-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38854100
—
WI
Enumeration date
03/30/2007
Last updated
06/12/2013
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