Provider Demographics
NPI:1336245265
Name:HEATH, LANCE CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:CHRISTOPHER
Last Name:HEATH
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 1:1405 S DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9709
Mailing Address - Country:US
Mailing Address - Phone:937-592-6321
Mailing Address - Fax:937-592-7644
Practice Address - Street 1:1405 S DETROIT ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9709
Practice Address - Country:US
Practice Address - Phone:937-592-6321
Practice Address - Fax:937-592-7644
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0869501Medicaid
OH341700807-00OtherWORK COMP PROVIDER NUMBER
000000351120OtherANTHEM BLUE CROSS BLUE SH
P00217158OtherRAIL ROAD MEDICARE
OHU39762Medicare UPIN
P00217158OtherRAIL ROAD MEDICARE