Provider Demographics
NPI:1497839534
Name:BOSSERMAN, LANCE C (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:C
Last Name:BOSSERMAN
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 1:1837 GOUCHER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-9506
Mailing Address - Country:US
Mailing Address - Phone:814-255-7292
Mailing Address - Fax:814-255-6742
Practice Address - Street 1:1837 GOUCHER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-9506
Practice Address - Country:US
Practice Address - Phone:814-255-7292
Practice Address - Fax:814-255-6742
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007072L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016512680001Medicaid
PAU67784Medicare UPIN
PA0016512680001Medicaid