Provider Demographics
NPI:1699989608
Name:COTTON, CHRIS LANCE (DC)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:LANCE
Last Name:COTTON
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 1:15051 HESPERIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3536
Mailing Address - Country:US
Mailing Address - Phone:510-276-7143
Mailing Address - Fax:866-870-8797
Practice Address - Street 1:15051 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3536
Practice Address - Country:US
Practice Address - Phone:510-276-7143
Practice Address - Fax:866-870-8797
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16320Medicare UPIN