Provider Demographics
NPI:1194044883
Name:LANEHART, JESSICA BROOKE (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:BROOKE
Last Name:LANEHART
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 1:2010 CENTRAL AVE EXT
Mailing Address - Street 2:SUITE F
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-1916
Mailing Address - Country:US
Mailing Address - Phone:229-273-2626
Mailing Address - Fax:229-273-2256
Practice Address - Street 1:2010 CENTRAL AVE EXT
Practice Address - Street 2:SUITE F
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-1916
Practice Address - Country:US
Practice Address - Phone:229-273-2626
Practice Address - Fax:229-273-2256
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor