Provider Demographics
NPI:1932411410
Name:COHEN, LANCE HAVENS (DC)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:HAVENS
Last Name:COHEN
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 1:8781 CUYAMACA ST
Mailing Address - Street 2:STE J
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4216
Mailing Address - Country:US
Mailing Address - Phone:619-449-0593
Mailing Address - Fax:619-449-0594
Practice Address - Street 1:8781 CUYAMACA ST
Practice Address - Street 2:STE J
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4216
Practice Address - Country:US
Practice Address - Phone:619-449-0593
Practice Address - Fax:619-449-0594
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor