Provider Demographics
NPI:1326148156
Name:LANZA, JOHN D (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:LANZA
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 1:18762 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3303
Mailing Address - Country:US
Mailing Address - Phone:818-342-2299
Mailing Address - Fax:818-342-7010
Practice Address - Street 1:18762 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3303
Practice Address - Country:US
Practice Address - Phone:818-342-2299
Practice Address - Fax:818-342-7010
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC9934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT03762Medicare UPIN
CADC9934Medicare ID - Type Unspecified