Provider Demographics
NPI:1265491047
Name:CHALFANT, LANCE ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ERIC
Last Name:CHALFANT
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 1:3350 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3636
Mailing Address - Country:US
Mailing Address - Phone:517-783-5805
Mailing Address - Fax:517-783-4287
Practice Address - Street 1:3350 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3636
Practice Address - Country:US
Practice Address - Phone:517-783-5805
Practice Address - Fax:517-783-4287
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MILC006854OtherBCBS REFERRRING NUMBER
MIT96988Medicare UPIN