Healthcare Provider Details

I. General information

NPI: 1255670295
Provider Name (Legal Business Name): CHELSEA LANNAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S SPRING ST
ODON IN
47562-1314
US

IV. Provider business mailing address

102 S SPRING ST
ODON IN
47562-1314
US

V. Phone/Fax

Practice location:
  • Phone: 812-636-8101
  • Fax:
Mailing address:
  • Phone: 812-636-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002696A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: