Provider Demographics
NPI:1659564185
Name:LANDER VALLEY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LANDER VALLEY CHIROPRACTIC, INC.
Other - Org Name:DUBOIS CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEHMKUHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-332-6148
Mailing Address - Street 1:906 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3040
Mailing Address - Country:US
Mailing Address - Phone:307-332-6148
Mailing Address - Fax:307-332-1361
Practice Address - Street 1:906 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3040
Practice Address - Country:US
Practice Address - Phone:307-332-6148
Practice Address - Fax:307-332-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY635261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYV01214Medicare UPIN
WYW20313Medicare PIN