Provider Demographics
NPI:1003095019
Name:LANNERT CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:LANNERT CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANNERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-697-8604
Mailing Address - Street 1:1302 W GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607-3705
Mailing Address - Country:US
Mailing Address - Phone:309-697-8604
Mailing Address - Fax:309-697-9298
Practice Address - Street 1:1302 W GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-3705
Practice Address - Country:US
Practice Address - Phone:309-697-8604
Practice Address - Fax:309-697-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07208137OtherBCBS
IL07208137OtherBCBS
IL=========OtherTIN
IL234480Medicare PIN