Provider Demographics
NPI:1750439451
Name:JEPPESEN, LANCE FIELDS (DC)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:FIELDS
Last Name:JEPPESEN
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 1:1146 SAN MARINO DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4649
Mailing Address - Country:US
Mailing Address - Phone:760-417-1477
Mailing Address - Fax:760-471-2083
Practice Address - Street 1:1146 SAN MARINO DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4649
Practice Address - Country:US
Practice Address - Phone:760-471-2033
Practice Address - Fax:760-471-2083
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17616Medicare PIN
CAT06520Medicare UPIN