Provider Demographics
NPI:1992990964
Name:DECKER, LANNY AVEN (DC)
Entity type:Individual
Prefix:DR
First Name:LANNY
Middle Name:AVEN
Last Name:DECKER
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 1:4225 N 21ST ST UNIT 19
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6161
Mailing Address - Country:US
Mailing Address - Phone:602-770-6927
Mailing Address - Fax:
Practice Address - Street 1:2642 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8243
Practice Address - Country:US
Practice Address - Phone:602-957-7733
Practice Address - Fax:602-957-8911
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor