Provider Demographics
NPI:1336510478
Name:LAWRENCE A ROSS DC
Entity Type:Organization
Organization Name:LAWRENCE A ROSS DC
Other - Org Name:DBA ORANGE AVE CHIROPRACTIC AND HEALTHCARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHRIOPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ANDEW
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-409-4774
Mailing Address - Street 1:5420 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-1319
Mailing Address - Country:US
Mailing Address - Phone:772-409-4774
Mailing Address - Fax:772-409-4774
Practice Address - Street 1:5420 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-1319
Practice Address - Country:US
Practice Address - Phone:772-409-4774
Practice Address - Fax:772-409-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty