Provider Demographics
NPI:1427145887
Name:TEACHWORTH, LANCE LAMAR (DC)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:LAMAR
Last Name:TEACHWORTH
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:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-0213
Mailing Address - Country:US
Mailing Address - Phone:402-879-4583
Mailing Address - Fax:785-875-4746
Practice Address - Street 1:KANSAS HWY 14
Practice Address - Street 2:
Practice Address - City:WEBBER
Practice Address - State:KS
Practice Address - Zip Code:66970
Practice Address - Country:US
Practice Address - Phone:785-875-3010
Practice Address - Fax:785-875-4746
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE48072096801Medicaid
753363Medicare ID - Type Unspecified
NE48072096801Medicaid