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General NPI Number Information
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NPI Number | 1427892090
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Entity Type | Organization
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Legal Business Name | LEBANON HEALTHCARE LLC
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 110 W SAINT LOUIS ST
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City | LEBANON
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State | IL
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Zip | 62254-1559
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Country | US
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Telephone | 618-654-4520
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Fax | 618-654-1063
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Provider Business Mailing Address
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Address Line | 1210 WASHINGTON ST
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City | HIGHLAND
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State | IL
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Zip | 62249-1925
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Country | US
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Telephone | 618-654-4520
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Fax | 618-654-1063
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Authorized Official
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Title or Position | OWNER
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Name | MARCUS ALVARADO
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Credential | DC
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Telephone | 618-304-7395
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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 |
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