Provider Demographics
NPI:1558950139
Name:LAUFFER, TREVOR RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:RICHARD
Last Name:LAUFFER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 KENILWORTH CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:HEATHROW
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5571
Mailing Address - Country:US
Mailing Address - Phone:717-379-3672
Mailing Address - Fax:
Practice Address - Street 1:1343 S INTERNATIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1401
Practice Address - Country:US
Practice Address - Phone:407-792-0705
Practice Address - Fax:407-792-0710
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor