Provider Demographics
NPI:1902128317
Name:LAMAR CHIROPRACTIC WELLNESS CENTER PSC
Entity Type:Organization
Organization Name:LAMAR CHIROPRACTIC WELLNESS CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKELEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-316-6347
Mailing Address - Street 1:PO BOX 22575
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-2575
Mailing Address - Country:US
Mailing Address - Phone:270-316-6347
Mailing Address - Fax:
Practice Address - Street 1:1605 SCHERM RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5300
Practice Address - Country:US
Practice Address - Phone:270-316-6347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty