Provider Demographics
NPI:1508299488
Name:PORTER, DEBORA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:LYNN
Last Name:PORTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 S RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-5169
Mailing Address - Country:US
Mailing Address - Phone:386-310-8766
Mailing Address - Fax:386-310-8770
Practice Address - Street 1:1367 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1529
Practice Address - Country:US
Practice Address - Phone:386-173-2000
Practice Address - Fax:386-265-5552
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor