Provider Demographics
NPI:1386636314
Name:FORD, LANCE EUGENE (DC)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:EUGENE
Last Name:FORD
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 1:612 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-1649
Mailing Address - Country:US
Mailing Address - Phone:417-358-3201
Mailing Address - Fax:417-358-4677
Practice Address - Street 1:612 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-1649
Practice Address - Country:US
Practice Address - Phone:417-358-3201
Practice Address - Fax:417-358-4677
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO758573406Medicaid
MO15148OtherBCBS
MO8851OtherCOX HEALTH SYSTEMS
MO168267OtherHEALTHLINK
PA4038239OtherHEALTHMARKET
PA4038239OtherHEALTHMARKET
MO758573406Medicaid