Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2592-012 | WI |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2592-012 | WI |
NPI | 1689863672 |
---|---|
Provider Name | Dr. Dane Eric Laughlin |
First Address | Superior, WI 54880-2550 |
Second Address | Superior, WI 54880-2550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2007 |
Last Update Date | 16/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38852700 | (05) | WI |
U25085 | (02) | WI |