Provider Demographics
NPI:1124190673
Name:BAUMANDER, LAURENCE DAVID (LMT)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:DAVID
Last Name:BAUMANDER
Suffix:
Gender:M
Credentials:LMT
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 358173
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635
Mailing Address - Country:US
Mailing Address - Phone:386-462-0970
Mailing Address - Fax:
Practice Address - Street 1:4101 NW 37TH PLACE, SUITE B
Practice Address - Street 2:DAWRIN CHIROPRACTIC CENTER
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6179
Practice Address - Country:US
Practice Address - Phone:352-377-2225
Practice Address - Fax:352-373-6436
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA15054225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC1301OtherBLUE CROSS BLUE SHIELD