Lice Clinics of America- Northwest Indiana

Primary specialty

Other TechnicianTaxonomy code 247200000X

Legal business name

LICE CLINICS OF AMERICA- NORTHWEST INDIANA

Practice address

1010 Breuckman Dr
Crown Point, IN 46307-7530

Phone

(219) 779-2289

NPI assigned

May 2, 2018

Last updated

May 2, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Randal Klackle

Title

Owner

Phone

(630) 624-4544

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525219200000",
    "number": "1083103485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18909 PARRISH AVE",
            "city": "LOWELL",
            "state": "IN",
            "postal_code": "463569618",
            "telephone_number": "630-624-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 BREUCKMAN DR",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077530",
            "telephone_number": "219-779-2289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICE CLINICS OF AMERICA- NORTHWEST INDIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-02",
        "last_updated": "2018-05-02",
        "status": "A",
        "authorized_official_last_name": "KLACKLE",
        "authorized_official_first_name": "RANDAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-624-4544"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Other Technician in Crown Point, IN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.