Provider Demographics
NPI:1508013095
Name:ECKENRODE, LANCE MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:MICHAEL
Last Name:ECKENRODE
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 1:9485 LINCOLN HWY
Mailing Address - Street 2:UNIT 1 LINCOLN CENTER II
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-3765
Mailing Address - Country:US
Mailing Address - Phone:814-623-6536
Mailing Address - Fax:
Practice Address - Street 1:444 E. PENN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-3765
Practice Address - Country:US
Practice Address - Phone:814-623-6536
Practice Address - Fax:814-623-6304
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor