Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 04432 | IA |
NPI | 1003817305 |
---|---|
Provider Name | Lance E Vanderloo |
First Address | Waterloo, IA 50701-4636 |
Second Address | Waterloo, IA 50702-5728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0032300 | (05) | IA |