Provider Demographics
NPI:1689888760
Name:LOMBARDO CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LOMBARDO CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:LOMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-485-9300
Mailing Address - Street 1:4337 FLAGSTAFF CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4400
Mailing Address - Country:US
Mailing Address - Phone:260-485-9300
Mailing Address - Fax:260-485-9336
Practice Address - Street 1:4337 FLAGSTAFF CV
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4400
Practice Address - Country:US
Practice Address - Phone:260-485-9300
Practice Address - Fax:260-485-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002194A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INV06428Medicare UPIN
231870Medicare ID - Type Unspecified