Provider Demographics
NPI:1609179456
Name:LANDER FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LANDER FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BURGUNDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-634-0126
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-0147
Mailing Address - Country:US
Mailing Address - Phone:815-518-5228
Mailing Address - Fax:815-634-3188
Practice Address - Street 1:415 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1405
Practice Address - Country:US
Practice Address - Phone:815-518-5228
Practice Address - Fax:815-634-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty