Provider Demographics
NPI:1174665640
Name:LAIRD, ALLAN D (DC)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:D
Last Name:LAIRD
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 1:2135 N OXNARD BLVD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2322
Mailing Address - Country:US
Mailing Address - Phone:805-918-3114
Mailing Address - Fax:
Practice Address - Street 1:4310 TRADEWINDS DR STE 300
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1410
Practice Address - Country:US
Practice Address - Phone:805-702-2500
Practice Address - Fax:805-233-3035
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005330L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0708615000OtherKEYSTONE
P8800487OtherOXFORD