Provider Demographics
NPI:1386682722
Name:HOOSE, LANCE A (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:A
Last Name:HOOSE
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 1:2442 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1749
Mailing Address - Country:US
Mailing Address - Phone:918-742-0560
Mailing Address - Fax:918-742-0605
Practice Address - Street 1:2442 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1749
Practice Address - Country:US
Practice Address - Phone:918-742-0560
Practice Address - Fax:918-742-0605
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$001OtherBLUE CROSS
OK$$$$$$$$$001OtherBLUE CROSS
OKU69569Medicare UPIN