Provider Demographics
NPI:1164441390
Name:LOMMELL, DANIEL R (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:LOMMELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 S OAKWOOD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1990
Mailing Address - Country:US
Mailing Address - Phone:309-945-4789
Mailing Address - Fax:309-945-4789
Practice Address - Street 1:1225 S OAKWOOD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1990
Practice Address - Country:US
Practice Address - Phone:309-945-4789
Practice Address - Fax:309-945-4789
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3726609OtherBLUE CROSS BLUE SHIELD
IL3726609OtherBLUE CROSS BLUE SHIELD