Provider Demographics
NPI:1265421952
Name:DUCHENE, LORI ANN (DC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:DUCHENE
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 1:1001 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2639
Mailing Address - Country:US
Mailing Address - Phone:406-563-6721
Mailing Address - Fax:
Practice Address - Street 1:1001 E PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2639
Practice Address - Country:US
Practice Address - Phone:406-563-6721
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT781 CHI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000163200Medicaid
MT41011OtherBLUE CROSS BLUE SHIELD
MT0000163200Medicaid