=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811032956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANOWAY CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1650 E HUEBBE PKWY STE A
-----------------------------------------------------
City | BELOIT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53511-6543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-365-0099
-----------------------------------------------------
Fax | 608-363-1111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1650 E HUEBBE PKWY STE A
-----------------------------------------------------
City | BELOIT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53511-6543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-365-0099
-----------------------------------------------------
Fax | 608-363-1111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GREGORY FRANK LANOWAY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 608-365-0099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1739
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------