Provider Demographics
NPI:1366503625
Name:KJENDALEN, LANCE EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:EDWARD
Last Name:KJENDALEN
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 1:1229 N LIMA RD
Mailing Address - Street 2:PO BOX 159
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755
Mailing Address - Country:US
Mailing Address - Phone:260-347-1637
Mailing Address - Fax:
Practice Address - Street 1:1229 N LIMA RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755
Practice Address - Country:US
Practice Address - Phone:260-347-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001989A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN98519OtherHEALTH PARTNERS
IN000000203325OtherANTHEM
IN7713361OtherAETNA
IN7713361OtherAETNA