Healthcare Provider Details

I. General information

NPI: 1912926650
Provider Name (Legal Business Name): BURGUNDY L LANDER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W DIVISION ST
COAL CITY IL
60416-1405
US

IV. Provider business mailing address

415 W DIVISION ST
COAL CITY IL
60416-1405
US

V. Phone/Fax

Practice location:
  • Phone: 815-518-5228
  • Fax: 815-634-3188
Mailing address:
  • Phone: 815-518-5228
  • Fax: 815-634-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009357
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: