Provider Demographics
NPI:1598800716
Name:LANZEN, CLINT STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:STEVEN
Last Name:LANZEN
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 1:1248 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3824
Mailing Address - Country:US
Mailing Address - Phone:303-678-9045
Mailing Address - Fax:
Practice Address - Street 1:1248 MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3824
Practice Address - Country:US
Practice Address - Phone:303-678-9045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-5270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC 809383Medicare PIN
COU90048Medicare UPIN