Healthcare Provider Details

I. General information

NPI: 1053178665
Provider Name (Legal Business Name): LUCY LEE SYVERSON LILLIE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 DINA CT
HIAWATHA IA
52233-4706
US

IV. Provider business mailing address

3198 COUNTRY PARK DR
TODDVILLE IA
52341-9728
US

V. Phone/Fax

Practice location:
  • Phone: 319-560-3316
  • Fax:
Mailing address:
  • Phone: 319-560-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number125049
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: