| East Side Chiropractic And Laser Therapy Center Llc | |
|
1624 E Mason St Green Bay WI 54302-2739 | |
| (920) 465-0400 | |
| Not Available |
| Full Name | East Side Chiropractic And Laser Therapy Center Llc |
|---|---|
| Speciality | Chiropractor |
| Location | 1624 E Mason St, Green Bay, Wisconsin |
| Authorized Official Name and Position | Michael Zastrow (OWNER) |
| Authorized Official Contact | 2094650400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Side Chiropractic And Laser Therapy Center Llc 1624 E Mason St Green Bay WI 54302-2739 Ph: (920) 465-0400 | East Side Chiropractic And Laser Therapy Center Llc 1624 E Mason St Green Bay WI 54302-2739 Ph: (920) 465-0400 |
| NPI Number | 1508506353 |
|---|---|
| Provider Enumeration Date | 03/30/2022 |
| Last Update Date | 04/10/2025 |
| Medicare PECOS PAC ID | 6002293693 |
|---|---|
| Medicare Enrollment ID | O20220520000858 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508506353 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 111N00000X | Chiropractor | (* (Not Available)) | Primary |
| Provider Name | Michael L Zastrow |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1275586075 PECOS PAC ID: 5597766550 Enrollment ID: I20070118000395 |
| Provider Name | Isaiah J Griesbach |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1447917703 PECOS PAC ID: 1153708748 Enrollment ID: I20220520001209 |
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