Provider Demographics
NPI:1356635031
Name:LAWRENCE, LATRICE SHANEE (DC)
Entity Type:Individual
Prefix:DR
First Name:LATRICE
Middle Name:SHANEE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LATRICE
Other - Middle Name:SHANEE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1406 POST OAK DR
Mailing Address - Street 2:UNIT H
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-3136
Mailing Address - Country:US
Mailing Address - Phone:312-316-5819
Mailing Address - Fax:
Practice Address - Street 1:1406 POST OAK DR
Practice Address - Street 2:UNIT H
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-3136
Practice Address - Country:US
Practice Address - Phone:312-316-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012307111N00000X
GACHIR008821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor