NPIMap

Organization Active NPI

Lutz Physical Medicine Corp

  • Chiropractor
  • Peoria, IL
National Provider Identifier
1578993606
Registry record updated Nov 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038011261 Issued in IL
Legal business name
LUTZ PHYSICAL MEDICINE CORP
Practice address
3105 N Prospect Rd
Jenessa Lutz
Peoria, IL 61603
Phone
(309) 840-3217
NPI assigned
Nov 27, 2013
Last updated
Nov 27, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jenessa Kalene Lutz, DCNPI 1174794200
Title
Chiropractor
Phone
(309) 840-3217

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038011261 IL Primary

Addresses

Primary practice location

3105 N Prospect Rd
Jenessa Lutz
Peoria, IL 61603

Mailing address

11547 Fuelberth Rd
Pekin, IL 61554-8247
Phone (309) 840-3217

Other identifiers 1

IdentifierTypeStateIssuer
1174794200OtherILNPI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385510400000",
    "number": "1578993606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11547 FUELBERTH RD",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615548247",
            "telephone_number": "309-840-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 N PROSPECT RD",
            "address_2": "JENESSA LUTZ",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61603",
            "telephone_number": "309-840-3217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTZ PHYSICAL MEDICINE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-27",
        "last_updated": "2013-11-27",
        "status": "A",
        "authorized_official_last_name": "LUTZ",
        "authorized_official_first_name": "JENESSA",
        "authorized_official_middle_name": "KALENE",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "309-840-3217",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1174794200",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.