Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | 4346 | WI |
N | 111NP0017X | Pediatric Chiropractor | 5340 | MN |
NPI | 1609054030 |
---|---|
Provider Name | Laura Lee Jonker |
First Address | Superior, WI 54880-3610 |
Second Address | Superior, WI 54880-3610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2008 |
Last Update Date | 12/07/2011 |