Provider Demographics
NPI:1508093741
Name:LANCE, HALEY BROGDEN (DC)
Entity Type:Individual
Prefix:DR
First Name:HALEY
Middle Name:BROGDEN
Last Name:LANCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HALEY
Other - Middle Name:RENE
Other - Last Name:BROGDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:946 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5877
Mailing Address - Country:US
Mailing Address - Phone:706-991-5320
Mailing Address - Fax:866-720-5313
Practice Address - Street 1:946 HARMONY RD
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-5877
Practice Address - Country:US
Practice Address - Phone:706-991-5320
Practice Address - Fax:866-720-5313
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008738111N00000X
AL2279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
511G700228Medicare PIN