Doctor Name: | DR. JENESSA KALENE LUTZ |
NPI Number: | 1174794200 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.C. |
License Number: | 038011261 |
Business Practice Address: | 3105 N Prospect Rd Peoria, IL - 616031505 |
Business Phone Number: | 3096855224 |
Business Fax Number: | 3096857377 |
Mailing Address: | 3105 N Prospect Rd, PEORIA |
State: | IL |
Postal Code: | 616031505 |
Phone Number: | 3096855224 |
Fax Number: | 3096857377 |
NPI Enumeration Date: | 03/17/2008 |
NPI Last Update Date: | 02/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 038011261 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |