MEDICARE: LEBANON HEALTHCARE LLC

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

General Provider Information

NPI Number	:	1427892090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEBANON HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1210 WASHINGTON ST
Second Line	:
City	:	HIGHLAND
State	:	IL
Zip	:	62249-1925
Country	:	US
Telephone Number	:	618-654-4520
Fax Number	:	618-654-1063

Provider Business Practice Location Address
First Line	:	110 W SAINT LOUIS ST
Second Line	:
City	:	LEBANON
State	:	IL
Zip	:	62254-1559
Country	:	US
Telephone Number	:	618-654-4520
Fax Number	:	618-654-1063

Authorized Official
Title or Position	:	OWNER
Name	:	MARCUS ALVARADO
Credential	:	DC
Telephone Number	:	618-304-7395

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	06/19/2024

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Directions to “LEBANON HEALTHCARE LLC ” Practice Location

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