Provider Demographics
NPI:1790946994
Name:WALENGA, LORI LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LYNN
Last Name:WALENGA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6575 BELDING RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7418
Mailing Address - Country:US
Mailing Address - Phone:616-874-8777
Mailing Address - Fax:616-874-8835
Practice Address - Street 1:6575 BELDING RD NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7418
Practice Address - Country:US
Practice Address - Phone:616-874-8777
Practice Address - Fax:616-874-8835
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2701148378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor