Provider Demographics
NPI:1477588895
Name:LENNON, JOSEPH LAWRENCE (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LAWRENCE
Last Name:LENNON
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 1:3801 LAS POSAS RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1427
Mailing Address - Country:US
Mailing Address - Phone:895-482-4193
Mailing Address - Fax:805-832-6187
Practice Address - Street 1:3687 LAS POSAS RD
Practice Address - Street 2:STE 185
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1431
Practice Address - Country:US
Practice Address - Phone:805-484-1990
Practice Address - Fax:805-388-8773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17519111N00000X
MO006296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T18560Medicare UPIN
MOC32449Medicare PIN