Healthcare Provider Details

I. General information

NPI: 1134553910
Provider Name (Legal Business Name): LANDER SPORT & HEALTH SCIENCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 KINGS HWY N
WESTPORT CT
06880-2428
US

IV. Provider business mailing address

125 KINGS HWY N
WESTPORT CT
06880-2428
US

V. Phone/Fax

Practice location:
  • Phone: 203-226-2366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number001472
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000254
License Number StateCT

VIII. Authorized Official

Name: DR. JOSHUA LANDER
Title or Position: MEMBER
Credential: DC, MS
Phone: 203-226-2366