Provider Demographics
NPI:1144202672
Name:LAWRENCE TEIXERIA DC PA
Entity Type:Organization
Organization Name:LAWRENCE TEIXERIA DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ISIDRO
Authorized Official - Last Name:TEIXEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-331-5050
Mailing Address - Street 1:817 DOUGLAS AVE
Mailing Address - Street 2:STE 179
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5200
Mailing Address - Country:US
Mailing Address - Phone:407-331-5050
Mailing Address - Fax:407-331-5189
Practice Address - Street 1:817 DOUGLAS AVE
Practice Address - Street 2:STE 179
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5200
Practice Address - Country:US
Practice Address - Phone:407-331-5050
Practice Address - Fax:407-331-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70060OtherBCBS
FL70060OtherBCBS