Provider Demographics
NPI:1477239853
Name:LORENZO-ROMAN, JOANNYS
Entity Type:Individual
Prefix:
First Name:JOANNYS
Middle Name:
Last Name:LORENZO-ROMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PINE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-4501
Mailing Address - Country:US
Mailing Address - Phone:787-464-8621
Mailing Address - Fax:
Practice Address - Street 1:117 PINE LANDING DR
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-4501
Practice Address - Country:US
Practice Address - Phone:787-464-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor