Provider Demographics
NPI:1699841171
Name:PULLIAM, LANCE ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ALAN
Last Name:PULLIAM
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 1:1800 N 11TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2004
Mailing Address - Country:US
Mailing Address - Phone:559-582-1933
Mailing Address - Fax:559-585-0624
Practice Address - Street 1:1800 N 11TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2004
Practice Address - Country:US
Practice Address - Phone:559-582-1933
Practice Address - Fax:559-585-0624
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22819OtherLICENSE NUMBER
CADC22819OtherLICENSE NUMBER
CADC0228190Medicare ID - Type Unspecified