Provider Demographics
NPI:1861512915
Name:CLOTHEY, LANCE LEROY I (DC)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:LEROY
Last Name:CLOTHEY
Suffix:I
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 1:7125 EL CAJON BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1851
Mailing Address - Country:US
Mailing Address - Phone:619-465-4880
Mailing Address - Fax:619-465-9487
Practice Address - Street 1:7125 EL CAJON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-1851
Practice Address - Country:US
Practice Address - Phone:619-465-4880
Practice Address - Fax:619-465-9487
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 15892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T18174Medicare UPIN
T18174Medicare ID - Type Unspecified