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General NPI Number Information
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NPI Number | 1053455972
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Entity Type | Organization
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Legal Business Name | NEW LENOX CHIROPRACTIC CENTER LTD
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 352 W MAPLE ST B
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City | NEW LENOX
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State | IL
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Zip | 60451-2953
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Country | US
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Telephone | 815-485-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 352 W MAPLE ST B
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City | NEW LENOX
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State | IL
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Zip | 60451-2953
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNERPRESIDENT
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Name | DR. DANA W JOHNSON
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Credential | DC
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Telephone | 815-485-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | IL
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