Healthcare Provider Details

I. General information

NPI: 1447210141
Provider Name (Legal Business Name): JAMES BRIAN LONNING ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST AVE E SUITE C
SPENCER IA
51301-4342
US

IV. Provider business mailing address

2019 120TH ST
BODE IA
50519-8533
US

V. Phone/Fax

Practice location:
  • Phone: 712-262-7511
  • Fax:
Mailing address:
  • Phone: 515-379-1284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number95
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: