Provider Demographics
NPI:1417459488
Name:LAURENCE H. CHURCHILL
Entity Type:Organization
Organization Name:LAURENCE H. CHURCHILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-212-7113
Mailing Address - Street 1:10 PINE COURSE WAY
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-8301
Mailing Address - Country:US
Mailing Address - Phone:386-212-7113
Mailing Address - Fax:
Practice Address - Street 1:1007 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0920
Practice Address - Country:US
Practice Address - Phone:352-732-2745
Practice Address - Fax:352-732-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty