Individual
DR. JACK ELLIS LORENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1770 JEFFERSON AVE, DEFIANCE, OH 43512
(419) 782-2250
(419) 784-2347
Mailing address
1770 JEFFERSON AVE, DEFIANCE, OH 43512
(419) 782-2250
(419) 784-2347
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
676
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000119614
ANTHEM
—
05
—
0340885
—
OH
Enumeration date
08/29/2006
Last updated
12/15/2010
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