Organization
LAKESIDE CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYNIE GOSSETT (BILLING COORDINATOR)
(262) 657-8434
Entity
Organization
Contact information
Practice address
5024 GREEN BAY RD STE 100, KENOSHA, WI 53144-1702
(262) 657-8434
(262) 657-8435
Mailing address
5024 GREEN BAY RD STE 100, KENOSHA, WI 53144-1702
(262) 657-8434
(262) 657-8435
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
02/13/2020
Last updated
02/13/2020
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