Provider Demographics
NPI:1659801140
Name:LEAN ON ME CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LEAN ON ME CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-605-5050
Mailing Address - Street 1:2138 W ROUSSEAU DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9152
Mailing Address - Country:US
Mailing Address - Phone:816-605-5050
Mailing Address - Fax:
Practice Address - Street 1:5624 N GOVERNMENT WAY STE 6
Practice Address - Street 2:
Practice Address - City:DALTON GARDENS
Practice Address - State:ID
Practice Address - Zip Code:83815-7350
Practice Address - Country:US
Practice Address - Phone:208-758-0200
Practice Address - Fax:816-605-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1768261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center