Provider Demographics
NPI:1669523908
Name:WEIDNER, LANCE LEE (DC)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:LEE
Last Name:WEIDNER
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 62897
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-2897
Mailing Address - Country:US
Mailing Address - Phone:719-590-7700
Mailing Address - Fax:
Practice Address - Street 1:7730 N UNION BLVD STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4075
Practice Address - Country:US
Practice Address - Phone:719-590-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4419111NX0100X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111N00000XChiropractic ProvidersChiropractor