Provider Demographics
NPI:1124009089
Name:LAUE, HAROLD LEE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:LEE
Last Name:LAUE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:H.
Other - Middle Name:LEE
Other - Last Name:LAUE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:855 N LARK ELLEN AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1099
Mailing Address - Country:US
Mailing Address - Phone:626-339-5437
Mailing Address - Fax:626-339-9978
Practice Address - Street 1:855 N LARK ELLEN AVE
Practice Address - Street 2:SUITE H
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1099
Practice Address - Country:US
Practice Address - Phone:626-339-5437
Practice Address - Fax:626-339-9978
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19888DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-4392944OtherFEDERAL TAX ID
CA95-4392944OtherFEDERAL TAX ID
CADC19888AMedicare ID - Type Unspecified