Provider Demographics
NPI:1285060954
Name:CLEVELAND, LANCE ELLIS (DC)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ELLIS
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HARDY COURT CTR
Mailing Address - Street 2:STE. 103
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-2501
Mailing Address - Country:US
Mailing Address - Phone:228-324-5883
Mailing Address - Fax:
Practice Address - Street 1:45 HARDY COURT CTR
Practice Address - Street 2:STE. 103
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-2501
Practice Address - Country:US
Practice Address - Phone:228-324-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor