Provider Demographics
NPI:1598984296
Name:LANZARA, RONALD FRED SR (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FRED
Last Name:LANZARA
Suffix:SR
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 1:340 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-3036
Mailing Address - Country:US
Mailing Address - Phone:603-889-2700
Mailing Address - Fax:603-889-2700
Practice Address - Street 1:340 BROAD STREET
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3036
Practice Address - Country:US
Practice Address - Phone:603-889-2700
Practice Address - Fax:603-889-2700
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH561A111N00000X
MA262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6104738Medicaid
U38905Medicare UPIN
MA6104738Medicaid