Provider Demographics
NPI:1023381092
Name:SHANK, LAWRENCE POWER (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:POWER
Last Name:SHANK
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-0068
Mailing Address - Country:US
Mailing Address - Phone:858-481-8282
Mailing Address - Fax:
Practice Address - Street 1:13895 MIRA MONTANA DR
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3111
Practice Address - Country:US
Practice Address - Phone:858-481-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 13679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor