Provider Demographics
NPI:1184184327
Name:MARTIN, LORA (ACUPUNCRTURE L AC)
Entity Type:Individual
Prefix:MISS
First Name:LORA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ACUPUNCRTURE L AC
Other - Prefix:MISS
Other - First Name:LORA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC
Mailing Address - Street 1:2323 RACE ST UNIT 815
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1084
Mailing Address - Country:US
Mailing Address - Phone:401-787-0454
Mailing Address - Fax:
Practice Address - Street 1:110 S 20TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4486
Practice Address - Country:US
Practice Address - Phone:401-787-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001173171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist