Provider Demographics
NPI:1376595363
Name:LANNON, CHRISTOPHER KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KEITH
Last Name:LANNON
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 1:28 WILLOW POND WAY
Mailing Address - Street 2:STE. 1
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2629
Mailing Address - Country:US
Mailing Address - Phone:585-377-3220
Mailing Address - Fax:585-377-4820
Practice Address - Street 1:28 WILLOW POND WAY
Practice Address - Street 2:STE. 1
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2629
Practice Address - Country:US
Practice Address - Phone:585-377-3220
Practice Address - Fax:585-377-4820
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY629531OtherACN
NY7611263OtherAETNA
NYPO10097421OtherBCBS
NYC09742-OBOtherWORKERS COMPENSATION
NY1376595363OtherNPI
NYFA0823OtherPREFERRED CARE
NYC09742-OBOtherNO FAULT
NY161614010OtherTAX ID
NYFA0823OtherPREFERRED CARE