Provider Demographics
NPI:1053589820
Name:LANCASTER CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LANCASTER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-404-1489
Mailing Address - Street 1:4736 EAGLERIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2120
Mailing Address - Country:US
Mailing Address - Phone:719-404-1489
Mailing Address - Fax:719-545-0642
Practice Address - Street 1:4736 EAGLERIDGE CIR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2120
Practice Address - Country:US
Practice Address - Phone:719-404-1489
Practice Address - Fax:719-545-0642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00371133Medicare PIN