=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336306695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOLLAR CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2008
-----------------------------------------------------
Last Update Date | 05/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 153 HARTNELL AVE SUITE 100
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96002-1856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-722-9012
-----------------------------------------------------
Fax | 530-722-9024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 153 HARTNELL AVE SUITE 100
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96002-1856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-722-9012
-----------------------------------------------------
Fax | 530-722-9024
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LESTER LANCE LOLLAR
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 530-722-9012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | DC20680
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------