Provider Demographics
NPI:1861676207
Name:PORTNOY, LORI E
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:E
Last Name:PORTNOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:E
Other - Last Name:PORTNOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:954 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4222
Mailing Address - Country:US
Mailing Address - Phone:773-248-2323
Mailing Address - Fax:
Practice Address - Street 1:954 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4222
Practice Address - Country:US
Practice Address - Phone:773-248-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK47671Medicare PIN