Provider Demographics
NPI:1457665606
Name:LANCE M POTTER PLLC
Entity Type:Organization
Organization Name:LANCE M POTTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-588-2237
Mailing Address - Street 1:1933 FARM ROAD 115
Mailing Address - Street 2:STE B
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-7434
Mailing Address - Country:US
Mailing Address - Phone:903-588-2237
Mailing Address - Fax:903-588-2239
Practice Address - Street 1:1933 FARM ROAD 115
Practice Address - Street 2:STE B
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-7434
Practice Address - Country:US
Practice Address - Phone:903-588-2237
Practice Address - Fax:903-588-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty