Organization
LUTZ PHYSICAL MEDICINE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENESSA KALENE LUTZ DC (CHIROPRACTOR)
(309) 840-3217
Entity
Organization
Contact information
Practice address
3105 N PROSPECT RD, JENESSA LUTZ, PEORIA, IL 61603
(309) 840-3217
Mailing address
11547 FUELBERTH RD, PEKIN, IL 61554-8247
(309) 840-3217
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038011261
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174794200
NPI
IL
Enumeration date
11/27/2013
Last updated
11/27/2013
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