Provider Demographics
NPI:1710096326
Name:KAESKE, LAURA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNN
Last Name:KAESKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:KAESKE
Other - Last Name:NIEDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1132 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3325
Mailing Address - Country:US
Mailing Address - Phone:847-607-8561
Mailing Address - Fax:847-236-1195
Practice Address - Street 1:2101 WAUKEGAN RD STE 100
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1836
Practice Address - Country:US
Practice Address - Phone:847-236-1194
Practice Address - Fax:847-236-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5091110OtherAETNA
IL211141Medicare ID - Type Unspecified
IL5091110OtherAETNA
U52947Medicare UPIN