Provider Demographics
NPI:1083692198
Name:LANZENDORFER, EDWARD MURRAY (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MURRAY
Last Name:LANZENDORFER
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 1:210 4TH AVE
Mailing Address - Street 2:PO BOX 624
Mailing Address - City:HASTINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16646-0624
Mailing Address - Country:US
Mailing Address - Phone:814-247-8440
Mailing Address - Fax:
Practice Address - Street 1:210 4TH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:PA
Practice Address - Zip Code:16646-0624
Practice Address - Country:US
Practice Address - Phone:814-247-8440
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004592L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1467534OtherUMWA
PA0014426240001Medicaid
PALA730186OtherBLUE SHIELD
PALA730186OtherBLUE SHIELD
PA1467534OtherUMWA