Provider Demographics
NPI:1427892090
Name:LEBANON HEALTHCARE LLC
Entity type:Organization
Organization Name:LEBANON HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-304-7395
Mailing Address - Street 1:1210 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1925
Mailing Address - Country:US
Mailing Address - Phone:618-654-4520
Mailing Address - Fax:618-654-1063
Practice Address - Street 1:110 W SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IL
Practice Address - Zip Code:62254-1559
Practice Address - Country:US
Practice Address - Phone:618-654-4520
Practice Address - Fax:618-654-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty