Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 3393-012 | WI |
Y | 111NP0017X | Pediatric Chiropractor | 3393-012 | WI |
NPI | 1578890497 |
---|---|
Provider Name | Dr. Zara Little Wing Lackman |
First Address | Wausau, WI 54401-7158 |
Second Address | Wausau, WI 54401-7158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2009 |
Last Update Date | 13/11/2009 |