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General NPI Number Information
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NPI Number | 1760268650
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Entity Type | Individual
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Provider Name | BENJAMIN LANZ DC
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Gender | Male
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 170 EXCHANGE AVE
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City | CONWAY
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State | AR
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Zip | 72032-7802
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Country | US
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Telephone | 512-774-9723
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Fax |
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Provider Business Mailing Address
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Address Line | 596 W REPUBLICAN RD
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City | GREENBRIER
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State | AR
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Zip | 72058-9037
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 16396
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License Number State | AR
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