Provider Demographics
NPI:1316989858
Name:LANZA FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:LANZA FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-729-7888
Mailing Address - Street 1:125 VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:VILLAS
Mailing Address - State:NJ
Mailing Address - Zip Code:08251-1345
Mailing Address - Country:US
Mailing Address - Phone:609-729-7888
Mailing Address - Fax:609-729-7855
Practice Address - Street 1:5207 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-4436
Practice Address - Country:US
Practice Address - Phone:609-729-7888
Practice Address - Fax:609-729-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00628100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086464Medicare ID - Type Unspecified