Provider Demographics
NPI:1275818437
Name:MCCLINTOCK, LANCE LYLE
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:LYLE
Last Name:MCCLINTOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 TIMMONS LN STE 135
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5965
Mailing Address - Country:US
Mailing Address - Phone:713-355-5343
Mailing Address - Fax:713-355-6999
Practice Address - Street 1:3100 TIMMONS LN STE 135
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5965
Practice Address - Country:US
Practice Address - Phone:713-355-5343
Practice Address - Fax:713-355-6999
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor