Provider Demographics
NPI:1235245077
Name:LAMCHICK, KENNETH PAUL (DC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:PAUL
Last Name:LAMCHICK
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 1:427 W DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1807
Mailing Address - Country:US
Mailing Address - Phone:815-664-4743
Mailing Address - Fax:
Practice Address - Street 1:427 W DAKOTA ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1807
Practice Address - Country:US
Practice Address - Phone:815-664-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009820120OtherBLUE CROSS BLUE SHIELD
IL341800Medicare ID - Type Unspecified
IL341800Medicare PIN
IL0009820120OtherBLUE CROSS BLUE SHIELD