Organization
INNER SPIRIT CHIROPRACTIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE L LACKNER DC (DC)
30968557777
Entity
Organization
Contact information
Practice address
4809 N SHERIDAN RD, PEORIA, IL 61614-5927
(309) 685-5777
(309) 685-5779
Mailing address
4809 N SHERIDAN RD, PEORIA, IL 61614-5927
(309) 685-5777
(309) 685-5779
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7227304
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/29/2006
Last updated
04/20/2008
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