Provider Demographics
NPI:1285641381
Name:LAWRENCE DELRE DC
Entity Type:Organization
Organization Name:LAWRENCE DELRE DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-431-4470
Mailing Address - Street 1:108 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1052
Mailing Address - Country:US
Mailing Address - Phone:412-431-4470
Mailing Address - Fax:
Practice Address - Street 1:108 HORIZON DR
Practice Address - Street 2:
Practice Address - City:VENETIA
Practice Address - State:PA
Practice Address - Zip Code:15367-1052
Practice Address - Country:US
Practice Address - Phone:412-431-4470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1642090OtherHIGHMARK BLUE SHIELD