Provider Demographics
NPI:1225677024
Name:LUMOS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:LUMOS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-285-8424
Mailing Address - Street 1:326 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2138
Mailing Address - Country:US
Mailing Address - Phone:541-285-8424
Mailing Address - Fax:
Practice Address - Street 1:24 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-9259
Practice Address - Country:US
Practice Address - Phone:541-895-4464
Practice Address - Fax:541-895-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty