Provider Demographics
NPI:1518085059
Name:FERKULA, LANCE ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:ROBERT
Last Name:FERKULA
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 1:8487 IVY HILL DR
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-5214
Mailing Address - Country:US
Mailing Address - Phone:330-757-8480
Mailing Address - Fax:
Practice Address - Street 1:520 YOUNGSTOWN POLAND RD
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1103
Practice Address - Country:US
Practice Address - Phone:330-755-1199
Practice Address - Fax:330-755-1299
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311545465-00OtherOHIO WORKER'S COMP
OH001756443002OtherUNITED HEALTHCARE
OH000000121636OtherANTHEM PROVIDER NUMBER
OH000000121636OtherANTHEM PROVIDER NUMBER
OH0812121Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER