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General NPI Number Information
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NPI Number | 1972801793
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Entity Type | Organization
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Legal Business Name | LANCE R. VANDERLOO CHIROPRACTIC L.L.C.
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 3731 KIMBALL AVE
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City | WATERLOO
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State | IA
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Zip | 50702-5728
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Country | US
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Telephone | 319-232-1143
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Fax | 319-232-3279
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Provider Business Mailing Address
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Address Line | 3731 KIMBALL AVE
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City | WATERLOO
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State | IA
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Zip | 50702-5728
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Country | US
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Telephone | 319-232-1143
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Fax | 319-232-3279
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. LANCE R VANDERLOO
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Credential | D.C.
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Telephone | 319-232-1143
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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 | 007388
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License Number State | IA
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