Healthcare Provider Details

I. General information

NPI: 1194751917
Provider Name (Legal Business Name): PAULA A LANZA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5207 PACIFIC AVE
WILDWOOD NJ
08260-4436
US

IV. Provider business mailing address

125 VILLAGE RD
VILLAS NJ
08251-1345
US

V. Phone/Fax

Practice location:
  • Phone: 609-729-7888
  • Fax: 609-729-7855
Mailing address:
  • Phone: 609-729-7888
  • Fax: 609-729-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00628100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: