Provider Demographics
NPI:1235115551
Name:AUDIRSCH, LANCE P (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:P
Last Name:AUDIRSCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1239 HIGHWAY 49
Mailing Address - Street 2:STE B
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 1:1239 HIGHWAY 49
Practice Address - Street 2:STE B
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-7239
Practice Address - Country:US
Practice Address - Phone:870-572-1500
Practice Address - Fax:870-572-7080
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR1257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128692718Medicaid
AR59878OtherBLUECROSS BLUESHIELD
AR59878OtherBLUECROSS BLUESHIELD
AR128692718Medicaid