Provider Demographics
NPI:1639267396
Name:HAGER, LANCE RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:RICHARD
Last Name:HAGER
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 1:2708 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4754
Mailing Address - Country:US
Mailing Address - Phone:307-362-3700
Mailing Address - Fax:307-362-9429
Practice Address - Street 1:2708 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4754
Practice Address - Country:US
Practice Address - Phone:307-362-3700
Practice Address - Fax:307-362-9429
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW303924Medicare ID - Type Unspecified