Provider Demographics
NPI:1366598385
Name:PITZER HANSON, LAURINE L (DC)
Entity type:Individual
Prefix:DR
First Name:LAURINE
Middle Name:L
Last Name:PITZER HANSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LAURINE
Other - Middle Name:L
Other - Last Name:PITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:245 N MASON AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:IL
Mailing Address - Zip Code:61310
Mailing Address - Country:US
Mailing Address - Phone:815-857-4705
Mailing Address - Fax:815-857-3091
Practice Address - Street 1:245 N MASON AVENUE
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:IL
Practice Address - Zip Code:61310
Practice Address - Country:US
Practice Address - Phone:815-857-4705
Practice Address - Fax:815-857-3091
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL#5282007OtherBCBS OF IL
IL#5282007OtherBCBS OF IL
T38475Medicare UPIN