Provider Demographics
NPI:1326348996
Name:LORENTZ, CARLIE ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLIE
Middle Name:ANNE
Last Name:LORENTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:ANNE
Other - Last Name:HUTCHINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1397 RILEY CIR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-8094
Mailing Address - Country:US
Mailing Address - Phone:386-227-7574
Mailing Address - Fax:
Practice Address - Street 1:1397 RILEY CIR
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-8094
Practice Address - Country:US
Practice Address - Phone:386-227-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10134111N00000X
WI4777-012111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Yes111N00000XChiropractic ProvidersChiropractor