Provider Demographics
NPI:1023414638
Name:JOHNSTON, LANCE (LAC)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37748 BLUETTE LN
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-6979
Mailing Address - Country:US
Mailing Address - Phone:310-200-5339
Mailing Address - Fax:
Practice Address - Street 1:37748 BLUETTE LN
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-6979
Practice Address - Country:US
Practice Address - Phone:310-200-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-08
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16358171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist