Provider Demographics
NPI:1316016108
Name:LINDNER, RUSSELL ALLEN (CHIROPRACTIC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ALLEN
Last Name:LINDNER
Suffix:
Gender:M
Credentials:CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 NORTH STATE ROAD 39
Mailing Address - Street 2:BOONE COUNTY CHIROPRACTIC OFFICE
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052
Mailing Address - Country:US
Mailing Address - Phone:765-482-1610
Mailing Address - Fax:765-482-9659
Practice Address - Street 1:3920 NORTH STATE ROAD 39
Practice Address - Street 2:BOONE COUNTY CHIROPRACTIC OFFICE
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052
Practice Address - Country:US
Practice Address - Phone:765-482-1610
Practice Address - Fax:765-482-9659
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000854A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
439600Medicare ID - Type Unspecified