Provider Demographics
NPI:1053800797
Name:DR. LANCE AUDIRSCH PA
Entity type:Organization
Organization Name:DR. LANCE AUDIRSCH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUDIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-572-1500
Mailing Address - Street 1:124 GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-2440
Mailing Address - Country:US
Mailing Address - Phone:870-572-1500
Mailing Address - Fax:870-572-7080
Practice Address - Street 1:124 GARLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-2440
Practice Address - Country:US
Practice Address - Phone:870-572-1500
Practice Address - Fax:870-572-7080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. LANCE AUDIRSCH PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128978718Medicaid
AR59878OtherBLUE CROSS BLUE SHIELD