Provider Demographics
NPI:1184035404
Name:LENNON CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:LENNON CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:LENNON
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:910-770-2436
Mailing Address - Street 1:1679 PEACOCK RD
Mailing Address - Street 2:APT A
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-8913
Mailing Address - Country:US
Mailing Address - Phone:910-770-2436
Mailing Address - Fax:
Practice Address - Street 1:800 25TH AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-4320
Practice Address - Country:US
Practice Address - Phone:910-770-2436
Practice Address - Fax:843-280-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty