Provider Demographics
NPI:1184224495
Name:LENTZ, MICHAEL (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LENTZ
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:FAIR GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65648-0434
Mailing Address - Country:US
Mailing Address - Phone:417-567-2001
Mailing Address - Fax:
Practice Address - Street 1:106 W OLD MILL RD
Practice Address - Street 2:
Practice Address - City:FAIR GROVE
Practice Address - State:MO
Practice Address - Zip Code:65648-8646
Practice Address - Country:US
Practice Address - Phone:417-567-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020035056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor