MEDICARE: DR. BRYAN LANEVILLE 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	038-010300	IL

General Provider Information

NPI Number	:	1558553172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN LANEVILLE D.C.

Provider Business Mailing Address
First Line	:	1510 PLAINFIELD RD STE 6
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-4919
Country	:	US
Telephone Number	:	630-325-5522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 PLAINFIELD RD STE 6
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-4919
Country	:	US
Telephone Number	:	630-325-5522
Fax Number	:

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	03/07/2025

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