Provider Demographics
NPI:1366529307
Name:KELLOW, LANCE E (DC)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:E
Last Name:KELLOW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 100TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3851
Mailing Address - Country:US
Mailing Address - Phone:515-270-1700
Mailing Address - Fax:515-270-1744
Practice Address - Street 1:2900 100TH ST STE 204
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3851
Practice Address - Country:US
Practice Address - Phone:515-270-1700
Practice Address - Fax:515-270-1744
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4766111N00000X
IA007063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV08392Medicare UPIN
MN350003579Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER