Provider Demographics
NPI:1760876007
Name:BACHELDER, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:BACHELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 NATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-1488
Mailing Address - Country:US
Mailing Address - Phone:309-344-1100
Mailing Address - Fax:309-344-2063
Practice Address - Street 1:1975 NATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1488
Practice Address - Country:US
Practice Address - Phone:309-344-1100
Practice Address - Fax:309-344-2063
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003466133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered