Provider Demographics
NPI:1780059295
Name:LOLIS, IPERLITTA VANCE (DC)
Entity type:Individual
Prefix:DR
First Name:IPERLITTA
Middle Name:VANCE
Last Name:LOLIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:IPERLITTA
Other - Middle Name:MECO
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:308 N GRAY ST # B
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-5245
Mailing Address - Country:US
Mailing Address - Phone:225-522-1380
Mailing Address - Fax:888-620-8147
Practice Address - Street 1:308 N GRAY ST # B
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-5245
Practice Address - Country:US
Practice Address - Phone:225-522-1380
Practice Address - Fax:888-620-8147
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1757111N00000X
TX13635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780059295OtherNPI
TX392409401Medicaid