Provider Demographics
NPI:1356404214
Name:HANEWOLD, LORI ANN (DC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:HANEWOLD
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 1:2707 KENNEDY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0488
Mailing Address - Country:US
Mailing Address - Phone:608-755-1035
Mailing Address - Fax:
Practice Address - Street 1:2707 KENNEDY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0488
Practice Address - Country:US
Practice Address - Phone:608-755-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3023-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000235805Medicare ID - Type Unspecified
WIU46203Medicare UPIN