Individual
DR. LANCE RICHARD VANDERLOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2230 W BURNSIDE ST STE D, PORTLAND, OR 97210-3727
(971) 255-1922
(971) 250-2884
Mailing address
2230 W BURNSIDE ST STE D, PORTLAND, OR 97210-3727
(971) 255-1922
(971) 250-2884
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
007388
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G8913150
MEDICARE PTAN
IA
Enumeration date
01/17/2011
Last updated
01/28/2015
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