Provider Demographics
NPI:1114255882
Name:LAWRENCE CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:LAWRENCE CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-965-4004
Mailing Address - Street 1:2734 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5956
Mailing Address - Country:US
Mailing Address - Phone:561-965-4004
Mailing Address - Fax:561-965-4030
Practice Address - Street 1:2734 FOREST HILL BLVD.
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5056
Practice Address - Country:US
Practice Address - Phone:561-965-4004
Practice Address - Fax:561-965-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001358111N00000X
FLCH1358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89306OtherMEDICARE
FL89306OtherMEDICARE