Provider Demographics
NPI:1447440516
Name:LANCASTER, KEVIN THOMAS (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:THOMAS
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 W SPRESSER ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1714
Mailing Address - Country:US
Mailing Address - Phone:217-287-1040
Mailing Address - Fax:217-287-1048
Practice Address - Street 1:1219 W SPRESSER ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1714
Practice Address - Country:US
Practice Address - Phone:217-287-1040
Practice Address - Fax:217-287-1048
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor