Healthcare Provider Details

I. General information

NPI: 1003095019
Provider Name (Legal Business Name): LANNERT CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 W GARFIELD AVE
BARTONVILLE IL
61607-3705
US

IV. Provider business mailing address

1302 W GARFIELD AVE
BARTONVILLE IL
61607-3705
US

V. Phone/Fax

Practice location:
  • Phone: 309-697-8604
  • Fax: 309-697-9298
Mailing address:
  • Phone: 309-697-8604
  • Fax: 309-697-9298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. LONNY J LANNERT
Title or Position: OWNER
Credential: DC
Phone: 309-697-8604