Provider Demographics
NPI:1912206590
Name:MOLLENHAUER, LANCE (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:
Last Name:MOLLENHAUER
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:PO BOX 2298
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-3043
Mailing Address - Country:US
Mailing Address - Phone:520-868-3605
Mailing Address - Fax:480-813-2987
Practice Address - Street 1:700 N. PINAL PARKWAY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132
Practice Address - Country:US
Practice Address - Phone:520-868-3605
Practice Address - Fax:480-813-2987
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ150399OtherPTAN
Z150398OtherPTAN