Individual
DR. LANCE RICHARD VANDERLOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
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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