Basic Information
| Provider Information | |||||||||
| NPI: | 1407935604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURRETT | ||||||||
| FirstName: | LANCE | ||||||||
| MiddleName: | CARLTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26603 INTERSTATE 45 | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813676900 | ||||||||
| FaxNumber: | 2813676255 | ||||||||
| Practice Location | |||||||||
| Address1: | 26603 INTERSTATE 45 | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813676900 | ||||||||
| FaxNumber: | 2813676255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2976 | TX | Y | Chiropractic Providers | Chiropractor |
No ID Information.