Provider Demographics
NPI:1124231378
Name:CHANDLER, LAUREN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:FALLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:901 S STATE ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7127
Mailing Address - Country:US
Mailing Address - Phone:951-652-8400
Mailing Address - Fax:
Practice Address - Street 1:901 S STATE ST
Practice Address - Street 2:SUITE 600
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7127
Practice Address - Country:US
Practice Address - Phone:951-652-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0216780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0216780Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAU74913Medicare UPIN