Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | IL |
NPI | 1003817479 |
---|---|
Provider Name | Dr. Lonny John Lannert |
First Address | Bartonville, IL 61607-3705 |
Second Address | Bartonville, IL 61607-3705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 12/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038136 | HEALTH ALLIANCE (01) | IL |
07208137 | BC / BS OF IL (01) | IL |
336665 | HEATHLINK (01) | IL |
U65423 | (02) | IL |