Provider Demographics
NPI:1376598862
Name:LANCASTER, BETH ANN (DC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4736 EAGLERIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2120
Mailing Address - Country:US
Mailing Address - Phone:719-404-1489
Mailing Address - Fax:719-545-0642
Practice Address - Street 1:4736 EAGLERIDGE CIR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2120
Practice Address - Country:US
Practice Address - Phone:719-404-1489
Practice Address - Fax:719-545-0642
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC460208Medicare ID - Type UnspecifiedCHIROPRACTIC