MEDICARE: DR. LONNY JOHN LANNERT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	336665	OTHER	IL	HEATHLINK
2	038136	OTHER	IL	HEALTH ALLIANCE
3	07208137	OTHER	IL	BC / BS OF IL

General Provider Information

NPI Number	:	1003817479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LONNY JOHN LANNERT D.C.

Provider Business Mailing Address
First Line	:	1302 W GARFIELD AVE
Second Line	:
City	:	BARTONVILLE
State	:	IL
Zip	:	61607-3705
Country	:	US
Telephone Number	:	309-697-8604
Fax Number	:	309-697-9298

Provider Business Practice Location Address
First Line	:	1302 W GARFIELD AVE
Second Line	:
City	:	BARTONVILLE
State	:	IL
Zip	:	61607-3705
Country	:	US
Telephone Number	:	309-697-8604
Fax Number	:	309-697-9298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/12/2008

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