Provider Demographics
NPI:1598808248
Name:LUMPKIN, VICKI L (DC, OMD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:L
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:DC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 22ND ST STE F
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6104
Mailing Address - Country:US
Mailing Address - Phone:630-792-9311
Mailing Address - Fax:630-792-9316
Practice Address - Street 1:400 E 22ND ST STE F
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6104
Practice Address - Country:US
Practice Address - Phone:630-792-9311
Practice Address - Fax:630-792-9316
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor