Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4419 | CO |
Y | 111NX0100X | Occupational Health | 4419 | CO |
NPI | 1669523908 |
---|---|
Provider Name | Lance Lee Weidner |
First Address | Colorado Springs, CO 80962-2897 |
Second Address | Colorado Springs, CO 80920-4075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 12/10/2009 |