Provider Demographics
NPI:1255670295
Name:LANNAN, CHELSEA (DC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:LANNAN
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 1:102 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:ODON
Mailing Address - State:IN
Mailing Address - Zip Code:47562-1314
Mailing Address - Country:US
Mailing Address - Phone:812-636-8101
Mailing Address - Fax:
Practice Address - Street 1:102 S SPRING ST
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562-1314
Practice Address - Country:US
Practice Address - Phone:812-636-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002696A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor