Provider Demographics
NPI:1073520854
Name:SEESHOLTZ, LANCE A (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:A
Last Name:SEESHOLTZ
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 1:2607 OLD BERWICK RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-3238
Mailing Address - Country:US
Mailing Address - Phone:570-784-2529
Mailing Address - Fax:570-784-1001
Practice Address - Street 1:2607 OLD BERWICK RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-3238
Practice Address - Country:US
Practice Address - Phone:570-784-2529
Practice Address - Fax:570-784-1001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU96358Medicare UPIN
PA072046Medicare ID - Type UnspecifiedCHIROPRACTIC