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General NPI Number Information
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NPI Number | 1134553910
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Entity Type | Organization
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Legal Business Name | LANDER SPORT & HEALTH SCIENCES, LLC
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 125 KINGS HWY N
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City | WESTPORT
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State | CT
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Zip | 06880-2428
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Country | US
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Telephone | 203-226-2366
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Fax |
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Provider Business Mailing Address
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Address Line | 125 KINGS HWY N
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City | WESTPORT
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State | CT
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Zip | 06880-2428
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JOSHUA LANDER
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Credential | DC, MS
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Telephone | 203-226-2366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000254
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | 001472
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License Number State | CT
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