Provider Demographics
NPI:1649526179
Name:LANCE WALD DC PA
Entity type:Organization
Organization Name:LANCE WALD DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:CARY
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-570-4080
Mailing Address - Street 1:100 S MILITARY TRL STE 18
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3031
Mailing Address - Country:US
Mailing Address - Phone:954-570-4080
Mailing Address - Fax:866-715-7529
Practice Address - Street 1:100 S MILITARY TRL STE 18
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3031
Practice Address - Country:US
Practice Address - Phone:954-570-4080
Practice Address - Fax:866-715-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty