Provider Demographics
NPI:1659443893
Name:LENNARTZ, THOMAS W (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:LENNARTZ
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 1:11276 WASHINGTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4620
Mailing Address - Country:US
Mailing Address - Phone:310-397-8972
Mailing Address - Fax:310-398-8252
Practice Address - Street 1:11276 WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4620
Practice Address - Country:US
Practice Address - Phone:310-397-8972
Practice Address - Fax:310-398-8252
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0195160Medicare UPIN