Provider Demographics
NPI:1942334941
Name:BAY AREA CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:BAY AREA CHIROPRACTIC CENTER LLC
Other - Org Name:EDWARD L LANWAY. D.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-269-2525
Mailing Address - Street 1:632 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1632
Mailing Address - Country:US
Mailing Address - Phone:541-269-2525
Mailing Address - Fax:541-269-7723
Practice Address - Street 1:632 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1632
Practice Address - Country:US
Practice Address - Phone:541-269-2525
Practice Address - Fax:541-269-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67833Medicare UPIN
ORR141464Medicare PIN
ORR120077Medicare PIN
ORR159396Medicare PIN
ORR153757Medicare PIN