Provider Demographics
NPI:1003242017
Name:WARNER, LAUREN (DC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-0091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E PALM DR
Practice Address - Street 2:SUITE E
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1984
Practice Address - Country:US
Practice Address - Phone:574-457-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002720A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor