Provider Demographics
NPI:1063203404
Name:LASPISA, DOMINIC SAMUEL
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:SAMUEL
Last Name:LASPISA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10590 W CORTEZ CIR APT 90-34
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2902
Mailing Address - Country:US
Mailing Address - Phone:847-507-2459
Mailing Address - Fax:
Practice Address - Street 1:20900 SWENSON DR STE 650
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2077
Practice Address - Country:US
Practice Address - Phone:414-600-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6309-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor