Provider Demographics
NPI:1073586467
Name:KLAES-LANHAM, MARIAN F (DC, ACUPUNCTURE)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:F
Last Name:KLAES-LANHAM
Suffix:
Gender:F
Credentials:DC, ACUPUNCTURE
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 747
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-0747
Mailing Address - Country:US
Mailing Address - Phone:812-522-2240
Mailing Address - Fax:812-522-9582
Practice Address - Street 1:1400 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2224
Practice Address - Country:US
Practice Address - Phone:812-522-2240
Practice Address - Fax:812-522-9582
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001035A111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1033380AMedicaid
IN1033380AMedicaid
INT34723Medicare UPIN