Provider Demographics
NPI:1053648048
Name:VANCE, HOWARD SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:SCOTT
Last Name:VANCE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E FOOTHILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1200
Mailing Address - Country:US
Mailing Address - Phone:909-399-9696
Mailing Address - Fax:909-399-0065
Practice Address - Street 1:520 E FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1200
Practice Address - Country:US
Practice Address - Phone:909-399-9696
Practice Address - Fax:909-399-0065
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31029111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician