Provider Demographics
NPI:1578633079
Name:LANZA, COLLEEN H (DC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:H
Last Name:LANZA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:HARTNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:123 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2909
Mailing Address - Country:US
Mailing Address - Phone:860-747-9326
Mailing Address - Fax:860-793-9323
Practice Address - Street 1:123 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2909
Practice Address - Country:US
Practice Address - Phone:860-747-9326
Practice Address - Fax:860-793-9323
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT436CT01OtherANTHEM
CTOV4405OtherLANDMARK
CT792374OtherCONNECTICARE
CT4137940OtherAETNA
CT792374OtherCONNECTICARE