Provider Demographics
NPI:1235753716
Name:DARK, LAUREN E
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:E
Last Name:DARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26731 DUBLIN WOODS CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7271
Mailing Address - Country:US
Mailing Address - Phone:239-200-7248
Mailing Address - Fax:
Practice Address - Street 1:26731 DUBLIN WOODS CIR STE 2
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7271
Practice Address - Country:US
Practice Address - Phone:239-200-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor