Provider Demographics
NPI:1437473592
Name:POTTER, LANCE MONROE (DC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:MONROE
Last Name:POTTER
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 1:421 FOREST LK
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-6982
Mailing Address - Country:US
Mailing Address - Phone:903-806-1850
Mailing Address - Fax:
Practice Address - Street 1:421 FOREST LK
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-6982
Practice Address - Country:US
Practice Address - Phone:903-806-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor